Ventriculoperitoneal shunt infection

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

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

Authors:

Ross Donaldson