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Cerebrospinal Fluid Shunt Infections in Children: Do Hematologic and Cerebrospinal Fluid White Cells Examinations
Danilo Buonsenso1,2,3, Federico Bianchi4, Giancarlo Scoppettuolo5
1From the Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS.
Insights
Pediatric cerebrospinal fluid (CSF) shunt infections are challenging to diagnose and manage. This study analyzed clinical, laboratory, and microbiologic data to better understand these infections in children.
Area of Science:
- Pediatric Neurosurgery
- Infectious Diseases
- Clinical Microbiology
Background:
- Cerebrospinal fluid (CSF) shunt infections in children are a growing clinical concern.
- Comprehensive clinical, laboratory, and microbiologic data for pediatric shunt infections are limited.
Purpose of the Study:
- To analyze clinical, laboratory, and microbiologic parameters of pediatric shunt infections.
- To evaluate results based on catheter type, infection recurrence, hydrocephalus type, and bacteremia.
- To describe antibiotic susceptibilities and their trends over time.
Main Methods:
- A 10-year retrospective study.
- Involved 87 children with shunt infections and 61 with mechanical shunt malfunction.
- Analyzed clinical, laboratory, microbiologic, and antibiotic susceptibility data.
Main Results:
- Infected children more frequently presented with fever, vomiting, leukocytosis, and elevated C-reactive protein.
- Medicated shunts had significantly lower CSF cell counts compared to non-medicated shunts.
- Gram-negative bacteria were prevalent in non-medicated catheters and CSF cultures; Enterococci were linked to relapsed infections.
Conclusions:
- Diagnosing and managing pediatric shunt infections presents significant challenges.
- Further prospective studies are needed to identify patient, medical, microbiologic, and surgical risk factors for initial infections.
Background:
Cerebrospinal fluid (CSF) shunt infections in children represent an increasing problem in clinical practice. However, comprehensive clinical, laboratory and microbiologic data are scarce in pediatric age.
Methods:
We conducted a 10-year retrospective study to (1) analyze clinical, laboratory and microbiologic parameters associated with infections in children; (2) analyze results according to the type of catheter (medicated or not), type of infection (first or relapses), type of hydrocephalus (acquired and congenital), presence or not of bacteriemia; (3) describe antibiotic susceptibilities and their evolution during the study period.
Results:
Eighty-seven children with shunt infection and 61 children with mechanical shunt malfunction were enrolled. Fever, vomit, leukocytosis and elevated C-reactive protein were more frequent in the infected group (P < 0.001), while neurologic symptoms developed more frequently in the noninfected group (10.3% vs. 27.87%; P = 0.006). Local signs of inflammation and abdomen distension were similarly reported in the 2 groups. Children with medicated shunts had lower cell count in the CSF (12/mm3) compared with those with nonmedicated shunts (380/mm3; P < 0.0001). Gram-negative bacteria were more common in the not-medicated catheters (90.91% vs. 50% of cultures; P = 0.04). Gram-negative bacteria were identified in 50.67% of CSF cultures, Gram-positive bacteria in 53.33% and fungi were observed in 5.33%. Sixteen children (18.4%) had also a positive blood culture. Enterococci isolation was associated with relapsed infections (37.50% vs. 15.25%; P = 0.05).
Conclusions:
Our study shows that the diagnosis and management of children with shunt infections are challenging. Prospective studies with a comprehensive approach focusing on patient, medical, microbiologic and surgical risk factors for first infection are urgently needed.
