title: Biofilm-associated infection: the hidden face of cerebrospinal fluid shunt malfunction.
abstract: Diagnosis of cerebrospinal fluid (CSF) shunt infection is difficult. Growing evidence links this pattern to biofilm-associated infections (BAI). Biofilm may explain the indolent development of the infection, and the poor efficiency of traditional microbiologic methods. We report the case of a patient admitted for hydrocephalus associated to CSF shunt malfunction. None of the clinical, serum, or CSF laboratory findings were in favor of an infectious process. Only scanning electron microscopy (SEM) revealed the presence of biofilm. Hence, despite a broad CSF shunt infection definition, some infections could remain undiagnosed by the traditional approach. This study is the first to provide some direct evidence for bacterial biofilm-associated CSF shunt infection.
authors.affiliation: Department of Anesthesia and Surgical Intensive Care, Paris XII School of Medicine, Henri Mondor University Hospital of Paris, Créteil, France. roman.mounier@laposte.net.|Anesthesia and Surgical Intensive Care Department, Henri Mondor University Hospital, 51, avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France. roman.mounier@laposte.net.
authors.forename: Roman
authors.initials: R
authors.lastname: Mounier
authors.affiliation: Department of Anesthesia and Surgical Intensive Care, Paris XII School of Medicine, Henri Mondor University Hospital of Paris, Créteil, France.
authors.forename: Natacha
authors.initials: N
authors.lastname: Kapandji
authors.affiliation: Department of Anesthesia and Surgical Intensive Care, Paris XII School of Medicine, Henri Mondor University Hospital of Paris, Créteil, France.
authors.forename: Ron
authors.initials: R
authors.lastname: Birnbaum
authors.affiliation: Department of Anesthesia and Surgical Intensive Care, Paris XII School of Medicine, Henri Mondor University Hospital of Paris, Créteil, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Cook
authors.affiliation: Department of Microbiology, Paris XII School of Medicine, Henri Mondor University Hospital of Paris, Créteil, France.
authors.forename: Cristophe
authors.initials: C
authors.lastname: Rodriguez
authors.affiliation: Department of Microbiology, Paris XII School of Medicine, Henri Mondor University Hospital of Paris, Créteil, France.
authors.forename: Bibba
authors.initials: B
authors.lastname: Nebbad
authors.affiliation: Department of Anesthesia and Surgical Intensive Care, Paris XII School of Medicine, Henri Mondor University Hospital of Paris, Créteil, France.
authors.forename: David
authors.initials: D
authors.lastname: Lobo
authors.affiliation: Department of Anesthesia and Surgical Intensive Care, Paris XII School of Medicine, Henri Mondor University Hospital of Paris, Créteil, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Dhonneur
mesh_terms: D018441:Biofilms; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects*; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery; D008297:Male; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000382:microbiology*; D055815:Young Adult
keywords: Biofilm; CSF shunt infection; Diagnosis; Scanning electron microscopy; Shunt malfunction; Sterile culture