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Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
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Management of Recurrent Ventriculoperitoneal Shunt Infections in Adult Patients
Neval Elgormus1, Yusuf Elgormus2, Bagnu Dundar3
1Department of Microbiology, Faculty of Medicine, Istanbul Atlas University, 34303 Istanbul, Turkey.
Antibiotics (Basel, Switzerland)
|January 25, 2025
Summary
Recurrent ventriculoperitoneal shunt (VPS) infections are often caused by resistant Gram-negative bacteria. Early monitoring and tailored antibiotic strategies, including carbapenem combinations, are crucial for managing these challenging VPS infections.
Area of Science:
- Neurosurgery
- Infectious Diseases
- Microbiology
Background:
- Ventriculoperitoneal shunt (VPS) infections pose a significant challenge in managing hydrocephalus.
- Understanding the microbiological and clinical factors associated with single (SVPS) and recurrent (RVPS) VPS infections is critical for effective treatment.
Purpose of the Study:
- To analyze the demographic, clinical, laboratory, and microbiological characteristics of VPS infections.
- To investigate bacterial agents and antibiotic susceptibility in SVPS and RVPS infections.
- To identify risk factors for recurrent VPS infections and evaluate treatment outcomes.
Main Methods:
- A 13-year retrospective study involving 110 patients with SVPS infections and 55 patients with RVPS infections.
- Analysis of bacterial pathogens, antibiotic susceptibility, and treatment regimens.
- Identification of clinical and laboratory parameters associated with infection recurrence.
Main Results:
- Gram-negative organisms were predominant in multiple infections (60%).
- High resistance rates were observed for third-generation cephalosporins (85.2%) and piperacillin-tazobactam (83.3%), with lower resistance to carbapenem (10.4%).
- Risk factors for RVPS included CNS tuberculosis, short antibiotic duration, high CSF/blood protein levels, and prolonged prophylactic antibiotics. A two-stage shunt replacement reduced recurrence.
Conclusions:
- Close monitoring of patients with identified risk factors for RVPS is essential.
- Empirical treatment should consider glycopeptide plus carbapenem due to resistant Gram-negative bacteria.
- Treatment strategies, such as third-generation cephalosporins plus glycopeptide, require revision based on clinical and microbiological data.
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