Ultra-Late shunt infection in the paediatric population

Area of Science:

• Neurosurgery
• Pediatric Infectious Diseases
• Medical Device Infections

Background:

• Shunt infections are common in pediatric neurosurgery, but ultra-late infections (beyond one year) are rare.
• These infections often present as fever and sepsis of unknown origin in shunted children.
• Investigating the incidence and causes of ultra-late shunt infections is crucial for improving patient outcomes.

Purpose of the Study:

• To determine the incidence of ultra-late shunt infections in pediatric neurosurgical patients.
• To identify the primary causes and causative microorganisms of these rare infections.
• To analyze risk factors and patterns associated with ultra-late shunt infections.

Main Methods:

• Retrospective study of shunt procedures from 2010-2025 in a single pediatric neurosurgical center.
• Inclusion criteria: pediatric patients (<18 years) with confirmed shunt infection presenting with pyrexia and requiring shunt externalization/removal.
• Analysis of patient demographics, hydrocephalus etiology, infection interval, risk factors, and isolated microorganisms.

Main Results:

• 15 cases of ultra-late shunt infection occurred among 1670 procedures (0.9% incidence).
• The mean interval between shunt insertion and infection was 4.74 years.
• Abdominal sepsis was the most common source, with Enterococcus species being the most frequent pathogen (33.3%).

Conclusions:

• Ultra-late shunt infections are exceedingly rare in pediatric neurosurgical patients.
• Abdominal pathology represents the most common source of these delayed infections.
• Prompt diagnosis and management involving shunt externalization, antibiotics, and re-internalization are essential.