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- | *Also caused by [[S. aureus]], [[Gram-negative]]s, [[anaerobes]] | ||
==Clinical Features== | ==Clinical Features== | ||
*Internal Infection | *Internal Infection | ||
**Mental status changes, | **[[AMS|Mental status changes]], [[headache]], [[nausea and vomiting]], irritability | ||
**Neck stiffness (33% of | **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 | ||
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{{VP shunt prob DDX}} | {{VP shunt prob DDX}} | ||
== | ==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== | ==Management== | ||
*Emergent neurosurgical consultation and admission | *Emergent neurosurgical consultation and admission | ||
*[[Antibiotics]] | *[[Antibiotics]] | ||
**[[Cefepime]]/[[Ceftazidime]] or [[carbapenem]] + [[vancomycin]] | **[[Cefepime]]/[[Ceftazidime]] or [[carbapenem]] + [[vancomycin]] | ||
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==Disposition== | ==Disposition== | ||
*Admit | |||
==See Also== | ==See Also== | ||
*[[Ventriculoperitoneal shunt problems]] | |||
==External Links== | ==External Links== | ||
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<references/> | <references/> | ||
[[Category: | [[Category:Neurology]] | ||
[[Category:ID]] | [[Category:ID]] | ||
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
- 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