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CSF Shunt Infections in Pediatrics: A Seven-Year Experience

CSF Shunt Infections in Pediatrics: A Seven-Year Experience Abstract • The medical records of children who had had CSF shunt procedures were reviewed for the seven-year period from 1975 through 1981. There were 516 procedures performed in 297 patients. Only three were ventriculoatrial shunts; the remainder were ventriculoperitoneal shunts. Fifty-nine infectious episodes (11%) occurred in 50 patients (17%); there were three relapses and six reinfections. The infecting pathogen was staphylococci in 75% of the infections and gram-negative bacilli in 19%, and there were two or more pathogens in 15% of the infections. The onset of the infection was within 15 days of surgery in 53% of the cases. The main symptoms were fever, irritability, and shunt malfunction. Gram's stain of the CSF was positive in 46% of the episodes and blood cultures were positive in 29%. Nineteen percent of patients had wound infection and 7% had peritonitis; in most of these cases there were no neurologic signs or symptoms. Thirteen episodes were managed with antibiotic therapy alone; among these, there were three relapses and two reinfections. Thirty-seven episodes were treated with antibiotics and immediate removal of the shunt; there were no relapses and three reinfections. Nine episodes were managed with antibiotics and delayed removal of the shunt; there was one reinfection. The median duration of antibiotic treatment was 15 days, and the time to defervescence was 24 hours in those with immediate removal of the shunt and six days in those in whom the shunt was not removed. (AJDC 1984;138:1103-1108) References 1. Robertson JS, Maragua MI, Fennett B: Ventriculoperitoneal shunting for hydrocephalus . Br Med J 1973;2:289-292.Crossref 2. Shoenbaum SC, Gardner P, Shillito J: Infections of cerebrospinal fluid shunts: Epidemiology, clinical manifestation, and therapy . J Infect Dis 1975;131:543-552.Crossref 3. Raimondi AJ, Robinson JS, Kuwamura K: Complications of ventriculoperitoneal-shunting and a critical comparison of the three-piece system and one-piece system . Childs Brain 1977;3: 321-342. 4. Yogev R, Davis T: Neurosurgical shunt infections . Childs Brain 1980;6:74-81. 5. George R, Liebrock L, Epstein M: Long-term analysis of cerebrospinal fluid shunt infections: A 25 year experience . J Neurosurg 1979; 51:804-811.Crossref 6. McCullough DC, Kane JG, Harleman G, et al: Antibiotic prophylaxis in ventricular shunt surgery: I. Reduction in operative infection rates with methicillin: II. Antibiotic concentrations in cerebrospinal fluid . Childs Brain 1980;7:182-189. 7. Everett ED, Eickhoff TC, Simon RH: Cerebrospinal fluid shunt infections with anaerobic diphtheroids (Propionibacterium species) . J Neurosurg 1976;44:580-584.Crossref 8. Rekate HL, Ruch T, Nielson FE: Diphtheroid infections of cerebrospinal fluid shunts: The changing pattern of shunt infections in Cleveland . J Neurosurg 1980;52:553-556.Crossref 9. Beeler BA, Crowder JG, Smith JW, et al: Propionibacterium acnes: Pathogen in central nervous system shunt infection . Am J Med 1976;61:935-938.Crossref 10. Moss SW, Gary NE, Eisinger RP: Nephritis associated with a diphtheroid-infected cerebrospinal fluid shunt . Am J Med 1977;63: 318-319.Crossref 11. Brook I, Johnson N, Overturf GD, et al: Mixed bacterial meningitis: A complication of ventriculo- and lumboperitoneal shunts: Report of two cases . J Neurosurg 1977;47:961-964.Crossref 12. Sells CJ, Joeser JD: Peritonitis following perforation of the bowel: A rare complication of ventriculoperitoneal shunt . J Pediatr 1973;83: 823-824.Crossref 13. Rubin RC, Chatak Nitya R, Visudhipam P: Asymptomatic perforated ventriculitis as a complication of valve-regulated ventriculoperitoneal shunts: Report of two cases . J Neurosurg 1972; 37:616-618.Crossref 14. Rekate HL, Yonas H, White RF, et al: The acute abdomen in patients with ventriculoperitoneal shunts . Surg Neurol 1979;11:442-445. 15. Foker EC: Occult infections of ventriculoatrial shunts . J Neurosurg 1970;33:517-521.Crossref 16. Bruce AM, Sorber J, Shedden WIH, et al: Persistent bacteremia following ventriculo-canal shunt operations for hydrocephalus in infants . Dev Med Child Neurol 1963;1:461-470. 17. Sells CJ, Shurtleff DB, Loeser JD: Gram-negative cerebrospinal fluid shunt-associated infections . Pediatrics 1977;59:614-618. 18. Hubschmann OR, Countee RW: Gram-positive peritonitis in patients with infected ventriculoperitoneal shunts . Surg Gynecol Obstet 1979;149:69-71. 19. Hubschmann OR, Countee RW: Acute abdomen in children with infected ventriculoperitoneal shunts . Arch Surg 1980;115:305-307.Crossref 20. Bayston R, Penny SR: Excessive production of mucoid substance in Staphylococcus S11A: A possible factor in colonization of Holter shunts . Dev Med Child Neurol 1972;14( (suppl 27) ):25-28. 21. Guevara JA, LaTorre J, Denoya C, et al: Microscopic studies in shunts for hydrocephalus . Childs Brain 1981;8:284-293. 22. Peters G, Locci R, Pulverer G: Adherence and growth of coagulase-negative staphylococci on surfaces of intravenous catheters . J Infect Dis 1982;146:479-482.Crossref 23. Farber BF, Moellering RC Jr: Retrospective study of the toxicity of preparations of vancomycin from 1974 to 1981 . Antimicrob Agents Chemother 1983;23:138-141.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Diseases of Children American Medical Association

CSF Shunt Infections in Pediatrics: A Seven-Year Experience

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Publisher
American Medical Association
Copyright
Copyright © 1984 American Medical Association. All Rights Reserved.
ISSN
0002-922X
DOI
10.1001/archpedi.1984.02140500009004
Publisher site
See Article on Publisher Site

Abstract

Abstract • The medical records of children who had had CSF shunt procedures were reviewed for the seven-year period from 1975 through 1981. There were 516 procedures performed in 297 patients. Only three were ventriculoatrial shunts; the remainder were ventriculoperitoneal shunts. Fifty-nine infectious episodes (11%) occurred in 50 patients (17%); there were three relapses and six reinfections. The infecting pathogen was staphylococci in 75% of the infections and gram-negative bacilli in 19%, and there were two or more pathogens in 15% of the infections. The onset of the infection was within 15 days of surgery in 53% of the cases. The main symptoms were fever, irritability, and shunt malfunction. Gram's stain of the CSF was positive in 46% of the episodes and blood cultures were positive in 29%. Nineteen percent of patients had wound infection and 7% had peritonitis; in most of these cases there were no neurologic signs or symptoms. Thirteen episodes were managed with antibiotic therapy alone; among these, there were three relapses and two reinfections. Thirty-seven episodes were treated with antibiotics and immediate removal of the shunt; there were no relapses and three reinfections. Nine episodes were managed with antibiotics and delayed removal of the shunt; there was one reinfection. The median duration of antibiotic treatment was 15 days, and the time to defervescence was 24 hours in those with immediate removal of the shunt and six days in those in whom the shunt was not removed. (AJDC 1984;138:1103-1108) References 1. Robertson JS, Maragua MI, Fennett B: Ventriculoperitoneal shunting for hydrocephalus . Br Med J 1973;2:289-292.Crossref 2. Shoenbaum SC, Gardner P, Shillito J: Infections of cerebrospinal fluid shunts: Epidemiology, clinical manifestation, and therapy . J Infect Dis 1975;131:543-552.Crossref 3. Raimondi AJ, Robinson JS, Kuwamura K: Complications of ventriculoperitoneal-shunting and a critical comparison of the three-piece system and one-piece system . Childs Brain 1977;3: 321-342. 4. Yogev R, Davis T: Neurosurgical shunt infections . Childs Brain 1980;6:74-81. 5. George R, Liebrock L, Epstein M: Long-term analysis of cerebrospinal fluid shunt infections: A 25 year experience . J Neurosurg 1979; 51:804-811.Crossref 6. McCullough DC, Kane JG, Harleman G, et al: Antibiotic prophylaxis in ventricular shunt surgery: I. Reduction in operative infection rates with methicillin: II. Antibiotic concentrations in cerebrospinal fluid . Childs Brain 1980;7:182-189. 7. Everett ED, Eickhoff TC, Simon RH: Cerebrospinal fluid shunt infections with anaerobic diphtheroids (Propionibacterium species) . J Neurosurg 1976;44:580-584.Crossref 8. Rekate HL, Ruch T, Nielson FE: Diphtheroid infections of cerebrospinal fluid shunts: The changing pattern of shunt infections in Cleveland . J Neurosurg 1980;52:553-556.Crossref 9. Beeler BA, Crowder JG, Smith JW, et al: Propionibacterium acnes: Pathogen in central nervous system shunt infection . Am J Med 1976;61:935-938.Crossref 10. Moss SW, Gary NE, Eisinger RP: Nephritis associated with a diphtheroid-infected cerebrospinal fluid shunt . Am J Med 1977;63: 318-319.Crossref 11. Brook I, Johnson N, Overturf GD, et al: Mixed bacterial meningitis: A complication of ventriculo- and lumboperitoneal shunts: Report of two cases . J Neurosurg 1977;47:961-964.Crossref 12. Sells CJ, Joeser JD: Peritonitis following perforation of the bowel: A rare complication of ventriculoperitoneal shunt . J Pediatr 1973;83: 823-824.Crossref 13. Rubin RC, Chatak Nitya R, Visudhipam P: Asymptomatic perforated ventriculitis as a complication of valve-regulated ventriculoperitoneal shunts: Report of two cases . J Neurosurg 1972; 37:616-618.Crossref 14. Rekate HL, Yonas H, White RF, et al: The acute abdomen in patients with ventriculoperitoneal shunts . Surg Neurol 1979;11:442-445. 15. Foker EC: Occult infections of ventriculoatrial shunts . J Neurosurg 1970;33:517-521.Crossref 16. Bruce AM, Sorber J, Shedden WIH, et al: Persistent bacteremia following ventriculo-canal shunt operations for hydrocephalus in infants . Dev Med Child Neurol 1963;1:461-470. 17. Sells CJ, Shurtleff DB, Loeser JD: Gram-negative cerebrospinal fluid shunt-associated infections . Pediatrics 1977;59:614-618. 18. Hubschmann OR, Countee RW: Gram-positive peritonitis in patients with infected ventriculoperitoneal shunts . Surg Gynecol Obstet 1979;149:69-71. 19. Hubschmann OR, Countee RW: Acute abdomen in children with infected ventriculoperitoneal shunts . Arch Surg 1980;115:305-307.Crossref 20. Bayston R, Penny SR: Excessive production of mucoid substance in Staphylococcus S11A: A possible factor in colonization of Holter shunts . Dev Med Child Neurol 1972;14( (suppl 27) ):25-28. 21. Guevara JA, LaTorre J, Denoya C, et al: Microscopic studies in shunts for hydrocephalus . Childs Brain 1981;8:284-293. 22. Peters G, Locci R, Pulverer G: Adherence and growth of coagulase-negative staphylococci on surfaces of intravenous catheters . J Infect Dis 1982;146:479-482.Crossref 23. Farber BF, Moellering RC Jr: Retrospective study of the toxicity of preparations of vancomycin from 1974 to 1981 . Antimicrob Agents Chemother 1983;23:138-141.Crossref

Journal

American Journal of Diseases of ChildrenAmerican Medical Association

Published: Dec 1, 1984

References