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Evaluation of an institutional guideline for the treatment of cerebrospinal fluid shunt-associated infections

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Abstract

Background

Cerebrospinal fluid (CSF) shunt-associated infection is one of the most frequent complications of CSF shunt surgery. We evaluated our institutional guideline for the treatment of shunt-associated infections.

Methods

We retrospectively analysed all 92 episodes of shunt-associated infections in 78 patients treated in our institution from 2002 to 2008. All patients underwent urgent surgery, i.e. removal of the complete shunt hardware or externalisation of the distal tubing in cases with an infection restricted to the distal shunt (10 %), placement of an external ventricular drainage as necessary and antibiotic therapy. Standard empirical first-line antibiotic treatment consisted of a combination of flucloxacillin and cefuroxime.

Results

We observed 38 % early (<1 month after shunt surgery) and 20 % late infections (> 1 year after shunt placement). Coagulase-negative staphylococci (CoNS) were isolated in 38 %. In 38 % no pathogens could be isolated. Of cases with a first shunt infection, 58 % were initially treated with flucloxacillin/cefuroxime. Only 53 % of all infections were treated successfully with the first course of antibiotics. Only 51 % of bacterial isolates were sensitive to empirical first-line antibiotics. Twenty percent of infections caused by sensitive bacterial isolates nevertheless required second-line antibiotic therapy.

Conclusions

Urgent surgery for shunt removal and antibiotic therapy will usually cure a shunt-associated infection. The choice of antibiotics should reflect the spectrum of pathogens seen at one’s institution, paying particular attention to the role of CoNS isolates, and in vitro sensitivity testing results.

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Authors and Affiliations

  1. Department of Neurosurgery, University Hospital Bonn, Sigmund Freud-Strasse 25, 53105, Bonn, Germany

    Christian von der Brelie & Matthias Simon

  2. Department of Paediatrics, University Hospital Bonn, Sigmund Freud-Strasse 25, 53105, Bonn, Germany

    Alexander Gröner

  3. Department of Microbiology, University Hospital Bonn, Sigmund Freud-Strasse 25, 53105, Bonn, Germany

    Ernst Molitor

  4. Paediatric Haematology and Oncology, University Children’s Hospital, Kirrberger Straße, 66421, Homburg/ Saar, Germany

    Arne Simon

  5. Department of Neurosurgery, University of Bonn Medical Center, Sigmund Freud Strasse 25, 53115, Bonn, Germany

    Christian von der Brelie

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  1. Christian von der Brelie
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Correspondence to Christian von der Brelie.

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von der Brelie, C., Simon, A., Gröner, A. et al. Evaluation of an institutional guideline for the treatment of cerebrospinal fluid shunt-associated infections. Acta Neurochir 154, 1691–1697 (2012). https://doi.org/10.1007/s00701-012-1329-x

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  • DOI: https://doi.org/10.1007/s00701-012-1329-x

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