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[Antibiotic therapy of infected cerebrospinal fluid in hydrocephalus treated by a shunt]
A Isla Guerrero1, P Peña García, V Ortega
1Servicio de Neurocirugía, Hospital La Paz, Madrid.
Insights
This study treated nine children with infected cerebrospinal fluid (CSF) shunts. A combined treatment protocol effectively sterilized CSF in all cases, highlighting effective antibiotic strategies for shunt infections.
Area of Science:
- Pediatric Neurosurgery
- Infectious Diseases
- Medical Device Infections
Context:
- Hydrocephalus is a common condition in children requiring cerebrospinal fluid (CSF) shunts.
- Infection of CSF shunts presents a significant challenge in pediatric neurosurgery.
- Diagnosis involves clinical evaluation, CSF analysis, and advanced imaging like CT scans.
Purpose:
- To evaluate the efficacy of a comprehensive treatment protocol for infected CSF shunts in pediatric patients.
- To identify common microorganisms responsible for CSF shunt infections.
- To determine the optimal antibiotic regimens for eradicating specific pathogens.
Summary:
- Nine hydrocephalic children (0-10 years) with infected CSF shunts were treated.
- The most frequent pathogen identified was Staphylococcus epidermidis, particularly in younger children.
- Treatment involved shunt external diversion, Ommaya reservoir implantation, and intraventricular/systemic antibiotics.
- CSF sterilization was achieved in all patients within 5-12 days.
- Intra-shunt vancomycin proved effective for S. epidermidis, and gentamycin for gram-negative infections.
Impact:
- The described protocol demonstrates high efficacy in treating pediatric CSF shunt infections.
- Establishes specific antibiotic recommendations for common pathogens like S. epidermidis and gram-negative bacteria.
- Offers a successful management strategy to prevent complications associated with shunt infections.
Abstract:
Nine hydrocephalic shunted children with infected cerebrospinal fluid (CSF) were treated. Ages ranged from 0 to 10 years. Diagnosis was made through clinical symptoms, CSF examination, echographic and computed tomography (CT). The microorganism which was seen more frequently, was S. epidermidis. This germ was more often found in young children. Treatment of these patients consisted of a systematic change of the shunt which was externally diverted, implantation of a CSF Ommaya reservoir in the lateral ventricle, and intraventricular and systemic administration of antibiotic, were made. Using this protocol CSF sterilization was obtained in all cases, after 5 to 12 days of treatment. CSF shunt infected with S. epidermidis can be effectively cleaned with daily intra-shunt vancomycin, and shunt infected with gram-negative are also cleaned with daily intra-shunt gentamycin.