CSF shunt infections in pediatrics. A seven-year experience
C. Odio, G. H. McCracken Jr and J. D. Nelson
The medical records of children who had had CSF shunt procedures were
reviewed for the seven-year period from 1975 through 1981. There were 516
procedures performed in 297 patients. Only three were ventriculoatrial
shunts; the remainder were ventriculoperitoneal shunts. Fifty-nine
infectious episodes (11%) occurred in 50 patients (17%); there were three
relapses and six reinfections. The infecting pathogen was staphylococci in
75% of the infections and gram-negative bacilli in 19%, and there were two
or more pathogens in 15% of the infections. The onset of the infection was
within 15 days of surgery in 53% of the cases. The main symptoms were
fever, irritability, and shunt malfunction. Gram's stain of the CSF was
positive in 46% of the episodes and blood cultures were positive in 29%.
Nineteen percent of patients had wound infection and 7% had peritonitis; in
most of these cases there were no neurologic signs or symptoms. Thirteen
episodes were managed with antibiotic therapy alone; among these, there
were three relapses and two reinfections. Thirty-seven episodes were
treated with antibiotics and immediate removal of the shunt; there were no
relapses and three reinfections. Nine episodes were managed with
antibiotics and delayed removal of the shunt; there was one reinfection.
The median duration of antibiotic treatment was 15 days, and the time to
defervescence was 24 hours in those with immediate removal of the shunt and
six days in those in whom the shunt was not removed.
