Variability in Management of First Cerebrospinal Fluid Shunt Infection: A Prospective Multi-Institutional Observational Cohort Study.
To describe the variation in approaches to surgical and antibiotic treatment for first cerebrospinal fluid (CSF) shunt infection and adherence to Infectious Diseases Society of America (IDSA) guidelines.



We conducted a prospective cohort study of children undergoing treatment for first CSF infection at 7 Hydrocephalus Clinical Research Network hospitals from April 2008 through December 2012. Univariate analyses were performed to describe the study population.



A total of 151 children underwent treatment for first CSF shunt-related infection. Most children had undergone initial CSF shunt placement before the age of 6 months (n =  98, 65%). Median time to infection after shunt surgery was 28 days (IQR 15-52 days). Surgical management was most often shunt removal with interim external ventricular drain placement, followed by new shunt insertion (n = 122, 81%). Median time from first negative CSF culture to final surgical procedure was 14 days (IQR 10-21 days). Median duration of intravenous (IV) antibiotic use duration was 19 days (IQR 12-28 days). For 84 infections addressed by IDSA guidelines, 7 (8%) met guidelines and 61 (73%) had longer duration of IV antibiotic use than recommended.



Surgical treatment for infection frequently adheres to IDSA guidelines of shunt removal with external ventricular drain placement followed by new shunt insertion. However, duration of IV antibiotic use in CSF shunt infection treatment was consistently longer than recommended by the 2004 IDSA guidelines.
Department of Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, WA; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA. Electronic address: Tamara.Simon@seattlechildrens.org.
Tamara D
TD
Simon
Department of Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, WA; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA.
Matthew P
MP
Kronman
Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA.
Kathryn B
KB
Whitlock
Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA.
Nancy
N
Gove
Department of Neurosurgery, University of Washington/Seattle Children's Hospital, Seattle, WA.
Samuel R
SR
Browd
Department of Pediatrics, University of Utah, Salt Lake City, UT.
Richard
R
Holubkov
Division of Pediatric Neurosurgery, Primary Children's Medical Center, Department of Neurosurgery, University of Utah, Salt Lake City, UT.
John R W
JR
Kestle
Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Toronto, Canada.
Abhaya V
AV
Kulkarni
Division of Pediatric Neurosurgery, Primary Children's Medical Center, Department of Neurosurgery, University of Utah, Salt Lake City, UT.
Marcie
M
Langley
Department of Neurosurgery, St. Louis Children's Hospital, Washington University in Saint Louis, St. Louis, MO.
David D
DD
Limbrick
Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, TX.
Thomas G
TG
Luerssen
Section of Pediatric Neurosurgery, Children's Hospital of Alabama, Division of Neurosurgery, University of Alabama - Birmingham, Birmingham, AL.
Jerry
J
Oakes
Division of Pediatric Neurosurgery, Primary Children's Medical Center, Department of Neurosurgery, University of Utah, Salt Lake City, UT.
Jay
J
Riva-Cambrin
Section of Pediatric Neurosurgery, Children's Hospital of Alabama, Division of Neurosurgery, University of Alabama - Birmingham, Birmingham, AL.
Curtis
C
Rozzelle
Section of Pediatric Neurosurgery, Children's Hospital of Alabama, Division of Neurosurgery, University of Alabama - Birmingham, Birmingham, AL.
Chevis
C
Shannon
Division of Neurosurgery, Children's Hospital of Pittsburgh, Pittsburgh, PA.
Mandeep
M
Tamber
Section of Pediatric Neurosurgery, Children's Hospital of Alabama, Division of Neurosurgery, University of Alabama - Birmingham, Birmingham, AL.
John C
JC
Wellons
Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, TX.
William E
WE
Whitehead
Department of Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, WA; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA.
Nicole
N
Mayer-Hamblett
D001424:Bacterial Infections / Q000209:etiology* / Q000628:therapy*; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects*; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000209:etiology* / Q000628:therapy*; D011446:Prospective Studies
antibiotic; cerebrospinal; infection; shunt; treatment
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