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Multiple recurrent gram-negative cerebrospinal fluid shunt infections associated with a patient with a retained
D Shingadia1, J Grant, M Bendet
1Division of Pediatric Infectious Diseases, Northwestern University Medical School, The Children's Memorial Hospital, Chicago, IL 60614, USA. dshingadia@nwu.edu
Abstract:
A 3-year-old boy experienced 10 recurrent gram-negative ventriculoperitoneal shunt (VPS) infections with identical strains over a 17-month period. Multiple cranial MRI and CT scans to identify a retained foreign body were negative. CT myelography and pressure infusion radionuclide cisternography were also unhelpful. Ventriculoscopy revealed a small retained foreign body which was successfully removed, and cultures subsequently yielded gram-negative organisms identical to the previously identified bacteria by pulsed field gel electrophoresis. No further infections were noted after removal of the retained fragment. Exploratory ventriculostomy should be considered in patients with recurrent VPS infections where other techniques fail to reveal a cause.
Insights
Recurrent ventriculoperitoneal shunt infections in a child were caused by a retained foreign body. Exploratory ventriculostomy is recommended when other methods fail to find the source of persistent shunt infections.
Area of Science:
- Neurosurgery
- Pediatric Infectious Diseases
- Medical Device Infections
Background:
- Recurrent ventriculoperitoneal shunt (VPS) infections pose significant challenges in pediatric neurosurgery.
- Identifying the source of persistent infections is crucial for effective management and preventing complications.
Observation:
- A 3-year-old boy presented with 10 recurrent gram-negative VPS infections over 17 months, caused by identical bacterial strains.
- Standard imaging (MRI, CT) and diagnostic procedures (CT myelography, radionuclide cisternography) failed to identify the infection's source.
Findings:
- Ventriculoscopy identified a small retained foreign body within the shunt system.
- Removal of the foreign body led to the resolution of gram-negative infections, confirmed by identical bacterial strain analysis (pulsed field gel electrophoresis).
Implications:
- Ventriculoscopy is a valuable tool for diagnosing retained foreign bodies in recurrent VPS infections.
- Exploratory ventriculostomy should be considered in refractory cases to uncover occult foreign bodies and resolve persistent shunt infections.