Ventriculoperitoneal shunt infection: Difference between revisions
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==Evaluation== | ==Evaluation== | ||
*Shunt tap (only done by neurosurgeon unless critically high ICP and no surgeon available) | |||
*Shunt tap | |||
**[[LP]] often misses CSF shunt infections and has no role when shunt infection is suspected | **[[LP]] often misses CSF shunt infections and has no role when shunt infection is suspected | ||
*Imaging | *Imaging | ||
**Useful to exclude mechanical shunt malfunction (often coexists with infection) | **Useful to exclude mechanical shunt malfunction (often coexists with infection) | ||
==Management== | |||
*Emergent neurosurgical consultation and admission | |||
*[[Antibiotics]] | *[[Antibiotics]] | ||
**[[Cefepime]]/[[Ceftazidime]] or [[carbapenem]] + [[vancomycin]] | **[[Cefepime]]/[[Ceftazidime]] or [[carbapenem]] + [[vancomycin]] | ||
Line 43: | Line 42: | ||
==Disposition== | ==Disposition== | ||
*Admit | |||
==See Also== | ==See Also== | ||
*[[Ventriculoperitoneal shunt problems]] | |||
==External Links== | ==External Links== |
Revision as of 11:37, 24 September 2016
Background
- Occurrence
- 50% within first 2 weeks of placement
- 70% within 2 months of placement
- 80% within 6 months of placement
- 10% present >1 year after surgery
Types
- External Infection
- Involve the subcutaneous tract around the shunt
- Internal Infection
- Involves the shunt and CSF contained within the shunt
Bacteriology
- 50% of cases caused by S. epidermidis
- Also caused by S. aureus, Gram-negatives, anaerobes
Clinical Features
- Internal Infection
- Mental status changes, headache, nausea and vomiting, irritability
- Neck stiffness (33% of patients)
- Fever is often absent
- Abdominal pain (VP shunt)
- External Infection
- Swelling, erythema, tenderness along site of shunt tubing
Differential Diagnosis
Ventriculoperitoneal shunt problems
- Ventriculoperitoneal shunt obstruction
- Ventriculoperitoneal shunt overdrainage (Slit Ventricle Syndrome)
- Ventriculoperitoneal shunt infection
- Ventriculoperitoneal shunt mechanical failure
Evaluation
- Shunt tap (only done by neurosurgeon unless critically high ICP and no surgeon available)
- LP often misses CSF shunt infections and has no role when shunt infection is suspected
- Imaging
- Useful to exclude mechanical shunt malfunction (often coexists with infection)
Management
- Emergent neurosurgical consultation and admission
- Antibiotics
Pediatric
- Empiric therapy: Vancomycin AND Cefotaxime 200 mg/kg/day IV div Q6 OR ceftriaxone 100 mg/kg/day IV div Q12-24
- Always involved neurosurgery in management
- Tailor antimicrobial therapy to culture results
Disposition
- Admit