State-of-the-Art Review: Infections in Patients With Cerebrospinal Fluid Shunts

Cerebrospinal fluid shunt infections pose major diagnostic and therapeutic challenges that necessitate multidisciplinary management and shared decision-making. However, published evidence to guide practice remains limited. This state-of-the-art review synthesizes current knowledge of the epidemiology, pathogenesis, and clinical presentation of these infections. Approaches to intravenous and intraventricular antimicrobial therapy are discussed, with particular attention to areas of persistent uncertainty. The role of neurosurgical interventions in the management of these infections is also reviewed. Emerging challenges, such as fungal and multidrug-resistant gram-negative shunt infections, are examined and key priorities for future research are outlined.