Cerebrospinal Fluid Shunt Infections in a Pediatric Cohort: Clinical Predictors and Microbiological Insights from a...

This study aims to identify epidemiological, microbiological, and laboratory characteristics of cerebrospinal fluid (CSF) shunt infections in children and evaluate associated risk factors.

Patients aged 0-18 years who underwent ventricular shunt placement at Gazi University Faculty of Medicine Hospital between January 1, 2010, and December 31, 2022, were retrospectively reviewed.

A total of 201 shunt procedures performed in 176 patients were analyzed, with infection occurring in 32 cases (15.9%). Infection rates were higher in subgaleal shunts (60%) than ventriculoperitoneal shunts (15.2%) (p = 0.018). Shunt infections developed in 31.7% of procedures involving at least one risk factor, compared with 5.7% of procedures without identified risk factors (p < 0.001). Preterm infants (<37 wks) had a higher infection rate (49%) than those born ≥37 weeks (14.5%) (p < 0.001). Gram-positive microorganisms accounted for 56.3% of infections, most commonly Staphylococcus sp., whereas Pseudomonas aeruginosa and Klebsiella species were the most frequent gram-negative pathogens (each 12.5%). Patients with gram-negative meningitis had a significantly higher intensive care unit admission rate than those with gram-positive meningitis (p = 0.021). In multivariate analysis, subgaleal shunt placement was associated with increased odds of shunt infection (OR: 12.13; CI: 1.36-107.69) (p = 0.025). In regression analysis, preterm birth was independently associated with an increased risk of shunt infection (OR: 6.12; CI: 2.02-18.56).

Shunt infection rates and microbial patterns align with existing literature. Preterm birth emerged as a major risk factor for shunt infection, whereas subgaleal shunt placement appeared to be a potential risk factor that warrants cautious interpretation and further validation. The increased severity of gram-negative infections underscores the need for stringent monitoring and preventive strategies in high-risk populations.