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Shunt infections: a review and analysis of a personal series

  • Santosh Mohan Rao Kanangi
  • Chidambaram Balasubramaniam
Special Annual Issue

Abstract

Introduction and purpose

CSF diversion shunts are notoriously prone to complications. The most difficult to manage among them is shunt infection, which warrants a prolonged hospital stay. The aim of this paper is to review the pattern of infections, the pathology, and management of shunt infections with special reference to a tertiary pediatric center in a developing country.

Materials and methods

This is a review of shunt infections in general and a retrospective study of all cases operated in the hospital from 2000 to 2015.

Results

The authors analyze the data and try to discern patterns, which may enable newer interventions to treat as well as decrease the burden of shunt infections in the future.

Conclusion

It is difficult to determine the true incidence of shunt infections as there is no definition of what constitutes a shunt infection. There are no standardized international guidelines as to how to deal with an infected shunt. Though the ability to treat shunt infection has improved and the incidence of shunt infection has decreased over time, there is still no consensus on the best way to manage it. The prevention is predominantly based on common sense and has helped but a more scientific algorithm is the need of the hour.

Keywords

Shunt infection Hydrocephalus Cerebrospinal fluid CNS infections CSF infections Antibiotic therapy Ventriculoperitoneal shunt 

Notes

Compliance with ethical standards

Conflict of interest

The authors have no disclosures to report.

References

  1. 1.
    Choux M, Genitori L, Lang D, Lena G (1992) Shunt implantation: reducing the incidence of shunt infection. JNS 77(6):875–880Google Scholar
  2. 2.
    Gutierrez-Murgas Y, Snowden JN (2014) VP shunt infections: immunopathogenesis and clinical management. J Neuroimmunol 276:1–8.  https://doi.org/10.1016/j.jneuroim.2014.08.006 CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Nelson Odio C, McCracken GH Jr, Nelson JD (1984) CSF Shunt infections in paediatrics. A 7-year experience. Am J Dis Children 138(12):1103–1108CrossRefGoogle Scholar
  4. 4.
    Bruinsma N, Stobberingh EE, Herpers MJHM, Vles JSH, Weber BJ, Gavilanes DAWD (2000) Subcutaneous ventricular catheter reservoir and VP drain-related infections in preterm infants and young children. Clin Microbiol Infect 6(4):202–206CrossRefPubMedGoogle Scholar
  5. 5.
    Gathura E, Poenaru D, Bransford R, Albright AL (2010a) Outcomes of VP shunt insertion in Subsaharan Africa. JNS Paeds 6(4):329–335Google Scholar
  6. 6.
    Younger JJ, Simmons JCH, Barrett FF (1987) Operative related infection rates for VP shunt procedures in children’s hospital. Infect Control 8(2):67–70CrossRefPubMedGoogle Scholar
  7. 7.
    Jenkinson MD, Gamble C, Griffiths M, Mallucci C et al (2014) BASICS: British antibiotic and silver impregnated catheters for VP shunts multi centre randomized controlled trial (BASICS trial). Trials 15:4. Published online 2014 Jan 3.  https://doi.org/10.1186/1745-6215-15-4 CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Simon TD, Whitlock KB, Riva-Cambrin J (2012a) Revision surgeries are associated with significant increased risk of subsequent cerebrospinal fluid shunt infection. Pediatr Infect Dis J 31(6):551–556.  https://doi.org/10.1097/INF.0b013e31824da5bd CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Sarmey N, VR K, Shriver MF, Habboub G, Machado AG, Weil RJ (2015) Evidence based interventions to reduce shunt infections: a systematic review. Childs Nerv Syst 31(4):541–549.  https://doi.org/10.10007/soo381-015-2637-2 CrossRefPubMedGoogle Scholar
  10. 10.
    Menon RG (2016) The war against shunt infections—fighting with our backs to the wall. Neurol India 64:608–609CrossRefPubMedGoogle Scholar
  11. 11.
    Tulipan N, Cleves MA (2006) Effect of an intra-operative double gloving strategy on the incidence of CSF infection. JNS 104(1 Suppl):5–8Google Scholar
  12. 12.
    Drake JM (2006) Does double gloving prevent CSF shunt infection? JNS 104(1 Suppl):3–4 discussion 4Google Scholar
  13. 13.
    Kestle JR, Riva-Cambrin J, Wellons JC (2011) A standardized protocol to reduce cerebrospinal fluid shunt infection: the hydrocephalus clinical research network quality improvement initiative. J Neurosurg Pediatr 8:22–29CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Heidari V, Habibi Z, Marvasti HA (2017) Different behavior and response of Staphylococcus epidermidis and Streptococcus pneumonia to a ventriculoperitoneal shunt: an in vitro study. Paediatr Neurosurg 52:257–260CrossRefGoogle Scholar
  15. 15.
    Orvin K, Bilavsky E, Weiner E (2009) Successful antibiotic eradication of Streptococcus pneumonia infection of a ventriculoatrial shunt. Int J Infect Dis 13:101–110CrossRefGoogle Scholar
  16. 16.
    O’Keefe PT, Bayston R (1991) Pneumococcal meningitis in a child with a ventriculo-peritoneal shunt. J Inf Secur 22:77–79Google Scholar
  17. 17.
    Nee LW, Harun R, Sellamuthu P, Idris Z (2017) Comparison between ventriculosubgaleal shunt and EVD to treat acute hydrocephalus in adults. Asian J Neurosurg 12(4):659–663CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Tubbs RS, Smyth MD, Wellons JC III, Blount JP, Grabb PA, Oakes WJ (2013) Alternative uses for the subgaleal shunt in paediatric neurosurgery. Padiatr Neurosurg 39:22–24.  https://doi.org/10.1159/000070875) CrossRefGoogle Scholar
  19. 19.
    Warf B (2005) Hydrocephalus in Uganda: The predominance of infectious origin and primary management with ETV. J Neurosurg 102:1–15PubMedGoogle Scholar
  20. 20.
    Warf B, East AFRICAN Neurosurgical Research Collaboration Paediatric hydrocephalus in East Africa: prevalence, causes, treatments and strategies for the future. World Neurosurg.  https://doi.org/10.1016/J.WNEU.2010.02.009
  21. 21.
    Vinchon M, Dhellemmes P (2006) Cerebrospinal fluid shunt infection: risk factors and long-term follow-up. Childs Nerv Syst 22:692–697CrossRefPubMedGoogle Scholar
  22. 22.
    Frykberg T, Olden L (1983) Infection as a cause of peritoneal catheter dysfunction in ventriculo-peritoneal shunting in children. Z Kinderchir 38(Suppl 2):84–86PubMedGoogle Scholar
  23. 23.
    Amacher AL, Wellington J (1984) Infantile hydrocephalus: long-term results of surgical therapy. Childs Brain 11:217–229PubMedGoogle Scholar
  24. 24.
    Cochrane DD, Kestle JR (2003) The influence of surgical operative experience on the duration of first ventriculoperitoneal shunt function and infection. Pediatr Neurosurg 38:295–301CrossRefPubMedGoogle Scholar
  25. 25.
    Kestle J, Drake J, Milner R (2000) Long-term follow-up data from the shunt design trial. Pediatr Neurosurg 33:230–236CrossRefPubMedGoogle Scholar
  26. 26.
    Borgbjerg BM, Gjerris F, Albeck MJ, Borgesen SE (1995) Risk of infection after cerebrospinal fluid shunt: an analysis of 884 first-time shunts. Acta Neurochir 136:1–7CrossRefPubMedGoogle Scholar
  27. 27.
    Di Rocco C, Marchese E, Velardi F (1994) A survey of the first complication of newly implanted CSF shunt devices for the treatment of nontumoral hydrocephalus. Cooperative survey of the 1991–1992 Education Committee of the ISPN. Childs Nerv Syst 10:321–327CrossRefPubMedGoogle Scholar
  28. 28.
    Braga MHV, Carvalho GTC, Brandao RACS, Lima DE, Costa BS (2009) Early shunt complications in 46 children with hydrocephalus. Arq Neuropsiquiatr 67(2a):273–277 Sao PauloCrossRefPubMedGoogle Scholar
  29. 29.
    Simon DT, Hall M, Riva-Cambrin J et al (2009) In collaboration with the hydrocephalus clinical research network. Infection rates following initial cerebrospinal fluid shunt placement across pediatric hospitals in the United States”. J Neurosurg Pediatrics 4:156–165CrossRefGoogle Scholar
  30. 30.
    Simon DT, Butler J, Whitlock KB, Kulkarni A, with the Hydrocephalus Clinical Research Network et al (2014) Risk factors for first cerebrospinal fluid shunt infection: findings from a multi-center prospective cohort study. J Pediatr 164:1462–1468CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Yakut N, Soysal A, Kadayifci EK et al. (2018) VP shunt infections and re-infections in children: a multicentre retrospective study. Br J Neurosurg 1-5 DOI:  https://doi.org/10.1080/02688697.2018.1467373
  32. 32.
    Kestle JR, Garton HJ, Whitehead WE (2006) Management of shunt infections: a multicenter pilot study. J Neurosurg 105(3 Suppl):177–181PubMedGoogle Scholar
  33. 33.
    Kulkarni AV, Rabin D, Lamberti-Pasculli M, Drake JM (2001) Repeat cerebrospinal fluid shunt infection in children. Pediatr Neurosurg 35:66–71CrossRefPubMedGoogle Scholar
  34. 34.
    McGirt MJ, Zaas A, Fuchs HE et al (2003) Risk factors for pediatric ventriculoperitoneal shunt infection and predictors of infectious pathogens. Clin Infect Dis 36:858–862CrossRefPubMedGoogle Scholar
  35. 35.
    Walters BC, Hoffman HJ, Hendrick EB, Humphreys RP (1984) Cerebrospinal fluid shunt infection. Influences on initial management and subsequent outcome. J Neurosurg 60:1014–1021CrossRefPubMedGoogle Scholar
  36. 36.
    Simon TD, Whitlock KB, Riva-Cambrin J (2012b) Association of intraventricular hemorrhage secondary to prematurity with cerebrospinal fluid shunt surgery in the first year following initial shunt placement. J Neurosurg Pediatr 9:54–63CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Whitehead WE, Kestle JR (2001) The treatment of cerebrospinal fluid shunt infections. Results from a practice survey of the American Society of Pediatric Neurosurgeons. Pediatr Neurosurg 35:205–210CrossRefPubMedGoogle Scholar
  38. 38.
    Enger PO, Svendsen F, Wester K (2003) CSF shunt infections in children: experiences from a population based study. Acta Neurochir 145(4):243–248CrossRefPubMedGoogle Scholar
  39. 39.
    Govender ST, Nathoo N, van Dellen (2003, JNS) Evaluation of antibiotic impregnated shunt system for the treatment of hydrocephalus. 99(5):831–839Google Scholar
  40. 40.
    Kandasamy J, Dwan K, Hartley JC, Jenkinson MD, Hayhurst C, Sy G, Thompson D, Crimmins D (2011) Antibiotic impregnated ventriculoperitoneal shunts—a multicenter Brititsh paediatric neurosurgery (BPNG) study using historic controls. Child Nerv Syst 27(4):575–581CrossRefGoogle Scholar
  41. 41.
    James G, Hartley JC, Morgan RD, Ternier J (2014) Effect of introduction of antibiotic impregnated shunt catheters on cerebrospinal fluid shunt infection in children: a large single center retrospective study. J Neurosurg Pediatr 13(1):101–106CrossRefPubMedGoogle Scholar
  42. 42.
    Kan P, Kestle JR (2007) Lack of efficacy of antibiotic-impregnated shunt systems in preventing shunt infections in children. Childs Nerv Syst 23(7):773–777CrossRefPubMedGoogle Scholar
  43. 43.
    Jost GF, Wasner M, Taub E, Walti L, Mariani L, Trampuz A (2014) Sonication of catheter tips for improved detection of microorganisms on external ventricular drains and ventriculo-peritoneal shunts. J Clin Neurosci 21(4):578–582CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Santosh Mohan Rao Kanangi
    • 1
  • Chidambaram Balasubramaniam
    • 1
  1. 1.Department of Pediatric NeurosurgeryKanchi Kamakoti CHILDS Trust HospitalChennai 34India

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