CSF shunt infections: a fifteen-year experience with emphasis on management and outcome

A retrospective study of patients with cerebrospinal fluid shunt infections was undertaken from 1975 to 1989 in a university hospital. The data were analyzed with emphasis on the choice of treatment and outcome. There were 44 infectious episodes in 38 patients for an overall rate of 2.6%, including 30 ventriculoperitoneal, 11 ventriculoatrial and 3 lumboperitoneal shunts. The most frequently isolated pathogens were staphylococci in 61% of the cases followed by gram-negative bacilli in 25%. Different modalities of treatment were used: support (2), intravenous antibiotics alone (6), intravenous antibiotics and shunt revision (3), intravenous antibiotics and shunt removal with or without prior externalization of the distal end (33: 13 + 20). The cure rate was 94% (31/33) with this last modality of treatment. Only 3 patients received intraventricular antibiotics. All deaths occurred in patients treated with support only (2) or with antibiotics alone (1). Four of the six recurrent episodes occurred in patients treated with antibiotics alone (2) or with a shunt revision (2). We conclude that carefully chosen intravenous antibiotics combined with shunt removal preceded or not by externalization of the distal end as an alternative therapy to repeated ventricular taps or insertion of an external ventricular drainage device is an appropriate therapy.