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Shunt infections in children: presentation and management
D G Williams1, J Hayes, S McCool
1Cardinal Glennon Children's Hospital, St. Louis, Missouri 63104, USA.
Insights
Hydrocephalus shunt infections are common in the first nine months post-surgery, often caused by Gram-positive bacteria. Early recognition of symptoms like fever and wound changes is crucial for effective management.
Area of Science:
- Neuroscience
- Pediatric Surgery
- Infectious Diseases
Background:
- Infection is a significant complication following surgical management of hydrocephalus.
- Neuroscience nurses require knowledge of hydrocephalus infection signs and management for optimal patient care.
Purpose of the Study:
- To review the incidence, causative organisms, and presenting symptoms of hydrocephalus shunt infections in children.
- To identify reliable diagnostic methods and discuss management strategies for these infections.
Main Methods:
- A retrospective review was conducted on 68 infections in 61 pediatric patients.
- Data collected included infection timing, microbial cultures, presenting symptoms, and laboratory findings.
Main Results:
- Infections occurred most frequently within the first nine months after surgery.
- Staphylococcus epidermidis and Staphylococcus aureus were the most common Gram-positive pathogens; Propionobacter acnes was noted in adolescents.
- Common presenting symptoms included fever, abdominal pain, wound changes, and signs of shunt malfunction.
Conclusions:
- Elevated white blood cell counts in cerebrospinal fluid and positive cultures are key diagnostic indicators.
- Prompt identification and management of hydrocephalus infections are essential for patient outcomes.
- A novel value-regulated ventricular drainage system enhancing patient mobility is presented.
Abstract:
Since the earliest attempt at surgical management of hydrocephalus, infection has been a significant complication. For better assessment and care the neuroscience nurse needs to be aware of the signs and management of this condition. A retrospective review of 68 infections in 61 children was undertaken. Results showed an increased incidence of infection in the first nine months after surgery. Gram positive organisms (Staphylococcus epidermidis and Staphylococcus aureus) were most frequent; Propionobacter acnes was a significant pathogen in adolescence. Presenting symptoms included fever (26%), abdominal pain (19%), wound changes (22%) and indicators of shunt malfunction (33%). Elevated white blood cells (WBCs) in spinal fluid from shunt tap and positive cultures were most reliable laboratory data. Culturing of causative organism was sometimes difficult. A value regulated system for ventricular drainage which allows greater mobility for the patient is described.