title: Audit of ventriculoperitoneal shunt infections in paediatric patients, 2006-2013.
abstract: BACKGROUND
  Infection following ventriculoperitoneal shunt placement remains a significant complication with an incidence of 3-27% cited in literature. Infections cause significant morbidity, and it is important that empirical antibiotic therapy for management is guided by accurate knowledge of prevailing aetiologies and local antibiotic sensitivity patterns.
  
  
  OBJECTIVE
  To establish the incidence of shunt infections in our paediatric population, to identify the causative micro-organisms, and to determine the antibiotic resistance patterns of the responsible micro-organisms.
  
  
  METHODS
  Retrospective data collection utilising existing databases in the Royal Hospital for Sick Children, Yorkhill, between 1 January 2006 and 30 September 2013.
  
  
  RESULTS
  Total number of shunt operations was 308 with 28 episodes of infection involving 27 patients (male = 12, female = 15). The incidence of infection was 9%. In all, 79% of the episodes involved a single pathogen with 21% being mixed pathogens. Coagulase-negative staphylococci were the most common cause of infection (44%). Gram-positive sensitivity to flucloxacillin and gentamicin was noticeably low at 22% and 14%, respectively with 87% of coagulase-negative staphylococci resistant to gentamicin and 81% resistant to flucloxacillin.
  
  
  CONCLUSIONS
  The changing spectrum of Gram-positive organisms has impacted on antibiotic sensitivity patterns, and our local prescribing policy has been adapted in order to manage shunt infections most effectively.
authors.affiliation: Paediatric Trainee Doctor, Department of Paediatric Surgery, Royal Hospital for Sick Children, UK mullanemily@gmail.com.
authors.forename: Emily
authors.initials: E
authors.lastname: Mullan
authors.affiliation: Principal Clinical Scientist, Department of Microbiology, Royal Hospital for Sick Children, UK.
authors.forename: Carol
authors.initials: C
authors.lastname: Lucas
authors.affiliation: Speciality Trainee Doctor, Department of Paediatric Surgery, Royal Hospital for Sick Children, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Mackie
authors.affiliation: Professor of Surgical Paediatrics, Department of Paediatric Surgery, Royal Hospital for Sick Children, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Carachi
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D054869:Clinical Audit; D020878:Device Removal; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D019983:Guideline Adherence; D006801:Humans; D015994:Incidence; D008297:Male; D010372:Pediatrics; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D012189:Retrospective Studies; D012606:Scotland / Q000453:epidemiology; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic resistance; paediatric; ventriculoperitoneal shunt infection