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Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Microbiology and Epidemiology of Pediatric and Young Adult Ventriculoperitoneal Shunt Infections
Kevin M Claunch1,2, Sarah DePerrior3, Michael Rajnik2
1Division of Pediatric Infectious Diseases, Walter Reed National Military Medical Center, Bethesda, MD, USA.
Insights
Pediatric ventriculoperitoneal (VP) shunt infections are often caused by Staphylococci. Current guidelines recommend vancomycin and an anti-pseudomonal beta-lactam for empiric therapy in children with VP shunt infections.
Area of Science:
- Pediatric Infectious Diseases
- Neurosurgery
- Clinical Microbiology
Background:
- Limited data exist on the microbiology and epidemiology of pediatric ventriculoperitoneal (VP) shunt infections.
- VP shunts are crucial for managing hydrocephalus in children, but infections pose significant risks.
Purpose of the Study:
- To characterize the microbiology and epidemiology of VP shunt infections in pediatric and young adult patients.
- To evaluate the appropriateness of current empiric antibiotic therapy for these infections.
Main Methods:
- Retrospective cohort study of 30 pediatric and young adult patients with VP shunt infections from 2008-2019.
- Infection confirmed by cerebrospinal fluid (CSF) or central nervous system (CNS) culture or CSF pleocytosis.
- Microbiological data analyzed to identify common pathogens and antibiotic sensitivities.
Main Results:
- Half of the patients were younger than 12 months; 57% were male.
- Staphylococci (coagulase-negative and Staphylococcus aureus) were the most frequent isolates (57.1%).
- Gram-negative pathogens accounted for 22.9% of infections.
- Vancomycin alone covered 73% of infections; 19% required broader coverage.
Conclusions:
- The findings support current national guidelines recommending vancomycin and an anti-pseudomonal beta-lactam for empiric treatment of pediatric VP shunt infections.
- Understanding the causative pathogens is essential for optimizing treatment strategies and improving patient outcomes.
- Further research is needed to refine antibiotic protocols for pediatric VP shunt infections.
Abstract:
There are limited data regarding the microbiology and epidemiology of pediatric ventriculoperitoneal (VP) shunt infections. We identified 30 pediatric and young adult VP shunt infections within the Military Health System from 2008 to 2019 by pairing a procedure code for VP shunt malfunction with a diagnosis code for VP shunt or central nervous system (CNS) infection. We confirmed infection with cerebrospinal fluid (CSF) or CNS culture or CSF pleocytosis for each patient. Half of patients were < 12 months old and 57% were male. The median initial CSF white blood cell count was 114 cells/µL. Staphylococci were identified most frequently (31.4% coagulase-negative staphylococci and 25.7% Staphylococcus aureus). Gram-negative pathogens comprised 22.9% of all isolates. Seventy-three percent of infections were adequately covered by vancomycin alone and 19% required a fourth-generation cephalosporin or carbapenem. Our study therefore supports national guideline-recommended empiric therapy with vancomycin and an anti-pseudomonal beta-lactam for children with VP shunt infection.
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