Ventriculoperitoneal shunt infection: Difference between revisions

 
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==Background==
==Background==
*Occurrence
*Occurrence
**50% within first 2 weeks of placement
**50% within first 2 weeks of placement/manipulation
**70% within 2 months of placement
**70% within 2 months of placement/manipulation
**80% within 6 months of placement
**80% within 6 months of placement/manipulation
**10% present >1 year after surgery
**10% present >1 year after surgery


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===Bacteriology===
===Bacteriology===
*50% of cases caused by S. epidermidis
*50% of cases caused by [[S. epidermidis]]
*Also caused by S. aureus, Gram-negatives, anaerobes
*Also caused by [[S. aureus]], [[Gram-negative]]s, [[anaerobes]]


==Clinical Features==
==Clinical Features==
*Internal Infection
*Internal Infection
**Mental status changes, headache, nausea and vomiting, irritability
**[[AMS|Mental status changes]], [[headache]], [[nausea and vomiting]], irritability
**Neck stiffness (33% of patients)
**Neck stiffness (33% of patients)
**Fever is often absent
**[[Fever]] is often absent
**Abdominal pain (VP shunt)
**[[Abdominal pain]] (VP shunt)
*External Infection
*External Infection
**Swelling, erythema, tenderness along site of shunt tubing
**Swelling, erythema, tenderness along site of shunt tubing

Latest revision as of 16:53, 3 October 2019

Background

  • Occurrence
    • 50% within first 2 weeks of placement/manipulation
    • 70% within 2 months of placement/manipulation
    • 80% within 6 months of placement/manipulation
    • 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

Clinical Features

Differential Diagnosis

Ventriculoperitoneal shunt problems

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

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

See Also

External Links

References