Infection after Harare valve V-P shunt operations: a review of 92 cases

Case files of 92 patients who had their hydrocephalus relieved by the insertion of the Harare Valve shunt system were reviewed. All patients had undergone surgery for shunt insertion at the Harare Central and Parirenyatwa Teaching Hospitals in Harare, Zimbabwe, between January 1986 and January 1988. All but one patient reviewed had Harare valve ventriculoperitoneal shunt insertions. The commonest indication for shunt insertion was congenital hydrocephalus alone or coexisting with other abnormalities (62 pc). Post meningitic hydrocephalus and hydrocephalus associated with intracranial tumours were next in frequency at 26 pc and 9 pc respectively. The etiology of hydrocephalus was not diagnosed in one four-year-old patient. The ages of the patients on admission ranged from one day to seven years (mean 12.4 months). Infection rates correlated well with the etiology of hydrocephalus; lowest (2 and half pc) in patients with simple congenital hydrocephalus and highest (29.2 pc) in post meningitic patients. A variety of organisms were isolated from CSF, blood, wounds and catheter tips. Lactose fermenting coliforms, S. epidermidis and E. coli predominated. Infection was combated by antibiotics, shunt removal or a combination of both. The antibiotics most commonly used were the penicillins, chloramphenicol, cloxacillin and gentamycin.