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Cerebrospinal Fluid Shunt Infections: A Multicenter Pediatric Study
Alastair McAlpine1, Joan L Robinson2, Michelle Barton3
1From the Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
Insights
Staphylococci are the most common cause of cerebrospinal fluid (CSF) shunt infections in children. Antibiotic-resistant Gram-negative bacilli are also a concern, but clinical features do not reliably predict them.
Area of Science:
- Pediatric Infectious Diseases
- Neurosurgery
- Microbiology
Background:
- Cerebrospinal fluid (CSF) shunt infections complicate 5%-10% of shunt placements.
- Understanding contemporary pathogens is crucial for effective treatment.
Purpose of the Study:
- To describe the characteristics and pathogens of CSF shunt infections in children across Canada and the United States.
Main Methods:
- A descriptive case series was conducted.
- Data were collected from 11 tertiary care hospitals between July 2013 and June 2019.
- Included were children up to 18 years of age with CSF shunt infections.
Main Results:
- 154 children experienced CSF shunt infections, with a median time to infection of 54 days post-placement.
- Coagulase-negative staphylococci (28%) and methicillin-susceptible Staphylococcus aureus (16%) were the most common pathogens.
- Antibiotic-resistant Gram-negative bacilli were identified, and empiric antibiotic regimens showed discordance in some cases.
Conclusions:
- Staphylococci continue to be the predominant cause of pediatric CSF shunt infections.
- Antibiotic-resistant Gram-negative bacilli are present but difficult to predict clinically.
- Variability in pathogen distribution and empiric antibiotic choices was noted across institutions.
Background:
Infections complicate 5%-10% of cerebrospinal fluid (CSF) shunts. We aimed to describe the characteristics and contemporary pathogens of shunt infections in children in Canada and the United States.
Methods:
Descriptive case series at tertiary care hospitals in Canada (N = 8) and the United States (N = 3) of children up to 18 years of age with CSF shunt infections from July 1, 2013, through June 30, 2019.
Results:
There were 154 children (43% female, median age 2.7 years, 50% premature) with ≥1 CSF shunt infections. Median time between shunt placement and infection was 54 days (interquartile range, 24 days-2.3 years). Common pathogens were coagulase-negative staphylococci (N = 42; 28%), methicillin-susceptible Staphylococcus aureus (N = 24; 16%), methicillin-resistant S. aureus (N = 9; 5.9%), Pseudomonas aeruginosa (N = 9; 5.9%) and other Gram-negative bacilli (N = 14; 9.0%). Significant differences between pathogens were observed, including timing of infection (P = 0.023) and CSF leukocyte count (P = 0.0019); however, differences were not sufficient to reliably predict the causative organism based on the timing of infection or discriminate P. aeruginosa from other pathogens based on clinical features. Empiric antibiotic regimens, which included vancomycin (71%), cefotaxime or ceftriaxone (29%) and antipseudomonal beta-lactams (33%), were discordant with the pathogen isolated in five cases. There was variability between sites in the distribution of pathogens and choice of empiric antibiotics. Nine children died; 4 (44%) deaths were attributed to shunt infection.
Conclusions:
Staphylococci remain the most common cause of CSF shunt infections, although antibiotic resistant Gram-negative bacilli occur and cannot be reliably predicted based on clinical characteristics.
