CSF shunt infections in pediatrics. A seven-year experience
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CSF shunt infections in children are common, with most caused by staphylococci. Immediate shunt removal with antibiotics is most effective in treating these infections.
Area of Science:
- Pediatric Neurosurgery
- Infectious Diseases
Background:
- Cerebrospinal fluid (CSF) shunts are crucial for managing hydrocephalus in children.
- Infections associated with CSF shunts pose significant risks, including morbidity and treatment challenges.
Purpose of the Study:
- To analyze the incidence, pathogens, and outcomes of CSF shunt infections in pediatric patients.
- To evaluate the effectiveness of different management strategies for CSF shunt infections.
Main Methods:
- Retrospective review of medical records for children undergoing CSF shunt procedures from 1975-1981.
- Analysis of 516 procedures in 297 patients, focusing on infectious episodes.
Main Results:
- 11% of procedures resulted in infection, with staphylococci being the most common pathogen (75%).
- 53% of infections occurred within 15 days of surgery, presenting with fever, irritability, and shunt malfunction.
- Immediate shunt removal combined with antibiotics showed no relapses and fewer reinfections compared to other methods.
Conclusions:
- CSF shunt infections are a significant complication in pediatric neurosurgery.
- Prompt diagnosis and aggressive management, particularly with immediate shunt removal and antibiotics, are critical for favorable outcomes.
- Understanding causative pathogens and infection timelines aids in optimizing treatment protocols.
Abstract:
The medical records of children who had had CSF shunt procedures were reviewed for the seven-year period from 1975 through 1981. There were 516 procedures performed in 297 patients. Only three were ventriculoatrial shunts; the remainder were ventriculoperitoneal shunts. Fifty-nine infectious episodes (11%) occurred in 50 patients (17%); there were three relapses and six reinfections. The infecting pathogen was staphylococci in 75% of the infections and gram-negative bacilli in 19%, and there were two or more pathogens in 15% of the infections. The onset of the infection was within 15 days of surgery in 53% of the cases. The main symptoms were fever, irritability, and shunt malfunction. Gram's stain of the CSF was positive in 46% of the episodes and blood cultures were positive in 29%. Nineteen percent of patients had wound infection and 7% had peritonitis; in most of these cases there were no neurologic signs or symptoms. Thirteen episodes were managed with antibiotic therapy alone; among these, there were three relapses and two reinfections. Thirty-seven episodes were treated with antibiotics and immediate removal of the shunt; there were no relapses and three reinfections. Nine episodes were managed with antibiotics and delayed removal of the shunt; there was one reinfection. The median duration of antibiotic treatment was 15 days, and the time to defervescence was 24 hours in those with immediate removal of the shunt and six days in those in whom the shunt was not removed.