Faculty Collaboration Database

Ventriculoperitoneal shunt infections with gram-negative bacteria. Neurosurgery 1993 Nov;33(5):858-62

Date

11/01/1993

Pubmed ID

8264883

DOI

10.1227/00006123-199311000-00011

Scopus ID

2-s2.0-0027363367 (requires institutional sign-in at Scopus site)   59 Citations

Abstract

Infection causes major morbidity and mortality in patients with cerebrospinal fluid (CSF) shunts. The prognosis of CSF shunt infections caused by Gram-negative bacteria (GNB) has been thought to be particularly poor. The authors reviewed all GNB shunt infections treated at Children's Memorial Hospital from January 1986 to January 1990 (n = 23). Of these infections 20 (87%) occurred within 4 weeks after shunt revision (median, 10 days). The most frequent symptoms were fever, lethargy, and irritability; the illness was not severe in the majority of these patients. Escherichia coli was isolated from 12 of 23 patients (52%), Klebsiella pneumoniae from 5 (22%), and mixed GNB from 3 (13%) patients. Initial treatment always included immediate shunt removal, externalized ventricular drainage, and intravenous antibiotics. Extraventricular drainage revision and/or intraventricular antibiotics were required in four patients whose CSF cultures were persistently positive for GNB. At admission, these patients had CSF glucose levels of < 10 mg/dl and CSF positive for GNB by Gram's stain. The overall cure rate was 100%, and no recurrence was observed; however, a subsequent infection with a different organism developed in four patients. Only 2 of 19 patients (11%) who were followed up suffered apparent CNS damage. One patient died of unrelated causes shortly after treatment. Our findings indicate that 1) patients with GNB CSF shunt infections often appear relatively well at presentation; 2) CSF positive for GNB by Gram's stain and very low CSF glucose levels predict continued positive CSF cultures, despite appropriate antibiotic therapy; and 3) GNB CSF shunt infections can be successfully treated by prompt shunt removal, extraventricular drainage, and intravenous antibiotics.(ABSTRACT TRUNCATED AT 250 WORDS)

Author List

Stamos JK, Kaufman BA, Yogev R

Author

Bruce A. Kaufman MD Adjunct Professor in the Neurosurgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Anti-Bacterial Agents
Bacteremia
Child
Child, Preschool
Combined Modality Therapy
Escherichia coli Infections
Female
Gram-Negative Bacterial Infections
Humans
Hydrocephalus
Infant
Infant, Newborn
Klebsiella Infections
Klebsiella pneumoniae
Male
Microbial Sensitivity Tests
Postoperative Complications
Reoperation
Staphylococcal Infections
Streptococcal Infections
Ventriculoperitoneal Shunt