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Nosocomial meningitis in children after ventriculoperitoneal shunt insertion
J Filka1, M Huttova, J Tuharsky
1Department of Pediatrics, University Hospital, Medical School, Kosice, Slovak Republic.
Insights
Ventriculoperitoneal shunt (VPS) meningitis occurred in 6.3% of pediatric patients, with coagulase-negative staphylococci being the most common pathogen. Prior meningitis and low birthweight were significant risk factors for VPS meningitis.
Area of Science:
- Pediatric Infectious Diseases
- Neurosurgery
- Clinical Microbiology
Background:
- Ventriculoperitoneal shunts (VPS) are crucial for managing hydrocephalus in children.
- Shunt-associated meningitis remains a significant complication, impacting patient outcomes.
- Understanding the epidemiology and risk factors of VPS meningitis is vital for prevention and treatment.
Purpose of the Study:
- To determine the incidence and causative organisms of ventriculoperitoneal shunt (VPS) meningitis in pediatric patients.
- To identify significant risk factors associated with the development of VPS meningitis.
- To provide data for improving infection control strategies in pediatric neurosurgery.
Main Methods:
- Retrospective review of 33 cases of VPS meningitis among 415 children undergoing 540 shunt insertions over 8 years.
- Data collected from 9 pediatric intensive care units across 5 centers in Slovakia.
- Statistical analysis to compare risk factors between VPS meningitis and non-VPS meningitis cases.
Main Results:
- The incidence of VPS meningitis was 6.3% per insertion.
- Coagulase-negative staphylococci (52.8%) were the most frequent pathogens, followed by Staphylococcus aureus (13.1%) and Pseudomonas aeruginosa (7.5%).
- Significant risk factors included prior meningitis with hydrocephalus, perinatal pathology, very low birthweight, polymicrobial nosocomial meningitis, and specific bacterial etiologies (S. aureus, coagulase-negative staphylococci, P. aeruginosa/Acinetobacter calcoaceticus).
Conclusions:
- VPS meningitis is a notable complication in pediatric neurosurgery, with specific microbial profiles.
- Several pre-existing conditions and infection characteristics significantly increase the risk of VPS meningitis.
- These findings underscore the need for targeted preventive measures and prompt management in high-risk pediatric populations.
Abstract:
This study reviews 33 cases of ventriculoperitoneal shunt (VPS) meningitis among 415 children after 540 shunt insertions within 8 y, in 9 paediatric intensive care units from 5 centres in Slovakia. The incidence of VPS meningitis was 6.3% per insertion. The most common organisms isolated from cerebrospinal fluid (CSF) and shunt were coagulase-negative staphylococci (52.8%), followed by Staphylococcus aureus (13.1%) and Pseudomonas aeruginosa (7.5%). Seven of 15 assessed risk factors were significantly associated with VPS meningitis, compared with non-VPS meningitis: prior meningitis with hydrocephalus (15.1 vs 1.5%, p < 0.015), perinatal pathology (51.1 vs 1.5%, p < 0.001), very low birthweight (66.6 vs 16.2%, p < 0.001), polymicrobial nosocomial meningitis (30.3 vs 5.9%, p < 0.002), S. aureus (21.2 vs 7.3%, p < 0.05), coagulase-negative staphylococci (84.8 vs 30.9%, p < 0.001) and P. aeruginosa and Acinetobacter calcoaceticus (30.3 vs 4.5%, p < 0.001) in aetiology.