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82 - Cerebrospinal fluid shunt infections

from Part X - Clinical syndromes: neurologic system

Published online by Cambridge University Press:  05 April 2015

Elisabeth E. Adderson
Affiliation:
University of Tennessee Health Science Center
Patricia M. Flynn
Affiliation:
St. Jude Children’s Research Hospital
David Schlossberg
Affiliation:
Temple University, Philadelphia
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Summary

Cerebrospinal fluid (CSF) shunts are critical for many patients surviving congenital central nervous system (CNS) anomalies, infection, or intracranial hemorrhage. Infection is a common complication of these devices and a leading cause of morbidity and hospitalization. Despite this, there is little consensus on the optimal means to prevent and treat these infections.

Pathogenesis

Most CSF shunts are silastic tubes inserted into the cerebral ventricles or subarachnoid space and connected to a pressure-regulating valve on the external skull. The proximal shunt is connected to tubing tunneled under the skin to the peritoneal cavity (ventriculoperitoneal shunt). In situations where intraperitoneal drainage is not feasible, the shunt may drain into the right atrium (ventriculoatrial shunt) or pleural cavity (ventriculopleural shunt).

The reported incidence of CSF shunt infections ranges from 1% to 30%, with an average of 10% in recent studies. Risk factors for infection include previous surgical revision, a short interval from the time of placement or revision, younger age (particularly premature neonates), a less-experienced surgeon, previous infection, endoscopic surgery, and the presence of a postoperative CSF leak. Prior cardiac surgery and any surgical procedure within 30 days of shunt insertion are risk factors for shunt infection in infants less than a year of age. Shunt valve design does not appear to influence infection rates.

Type
Chapter
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Publisher: Cambridge University Press
Print publication year: 2015

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References

Brown, EM, Edwards, RJ, Pople, IK.Conservative management of patients with cerebrospinal fluid shunt infections. Neurosurgery. 2006;58:657–665.CrossRefGoogle ScholarPubMed
Klimo, P, Thompson, CJ, Ragel, BT, Boop, FA. Antibiotic-impregnated shunt systems versus standard shunt systems: a meta- and cost-savings analysis. J Neursurg Pediatr. 2011;8:600–612.CrossRefGoogle ScholarPubMed
Kestle, JRW, Riva-Cambrin, J, Wellons, JC, et al. A standardized protocol to reduce cerebrospinal fluid shunt infection: the Hydrocephalus Clinical Research Network Quality Improvement Initiative. J Neurosurg Pediatr. 2011;8:22–29.CrossRefGoogle ScholarPubMed
James, HE, Walsh, JW, Wilson, HD, et al. Prospective randomized study of therapy in cerebrospinal fluid shunt infection. Neurosurgery. 1980;7:459–463.CrossRefGoogle ScholarPubMed
Ng, K, Mabasa, VH, Chow, I, Ensom, MH. Systematic review of efficacy, pharmacokinetics, and administration of intraventricular vancomycin. Neurocrit Care. 2014;20:158–171. .CrossRefGoogle ScholarPubMed
Ratilal, BO, Costa, J, Sampaio, C. Antibiotic prophylaxis for surgical introduction of intracranial ventricular shunts. Cochrane Database Syst Rev. 2006;(3):CD005365. .
Schreffler, RT, Schreffler, AJ, Wittler, RR. Treatment of cerebrospinal fluid shunt infections: a decision analysis. Pediatr Infect Dis J. 2002;21:632–636.CrossRefGoogle ScholarPubMed

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