Empiric Antibiotic Prescription Patterns in Children With Cerebrospinal Fluid Shunt Infection

Area of Science:

• Pediatric Infectious Diseases
• Antimicrobial Stewardship
• Neurosurgery

Background:

• Infectious Diseases Society of America guidelines recommend vancomycin plus an antipseudomonal beta-lactam for CSF shunt infections.
• Empiric antibiotic selection should consider local susceptibility patterns.

Purpose of the Study:

• To determine patterns of inpatient antibiotic use in children receiving empiric treatment for cerebrospinal fluid (CSF) shunt infections.
• To assess adherence to Infectious Diseases Society of America guidelines for empiric CSF shunt infection therapy.

Main Methods:

• Retrospective, observational cohort study at 6 tertiary care children's hospitals.
• Included children with first CSF shunt infection after initial shunt placement surgery (2007-2012).
• Analyzed empiric antimicrobial use (antibiotics ordered day before, of, or after surgery, before culture results).

Main Results:

• Vancomycin was the most common empiric antibiotic (85.6%).
• Few children received guideline-recommended combinations: vancomycin with cefepime (3.6%), ceftazidime (0%), or meropenem (0.5%).
• No significant change in antimicrobial coverage patterns observed over the study period.

Conclusions:

• Empiric therapy for pediatric CSF shunt infections often deviates from guidelines.
• Antimicrobial stewardship programs have a key opportunity to improve guideline concordance and antibiotic use.
• Optimizing empiric antibiotic selection is crucial for managing pediatric shunt infections.