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Ventriculoperitoneal Shunt Infection and Treatment in Children

Year 2015, Volume: 40 Issue: 1, 72 - 79, 09.09.2015
https://doi.org/10.17826/cutf.09848

Abstract

Purpose: The most important complication of ventriculoperitoneal shunt (VPS) surgery is central nervous system infections developing in the postoperative period. The incidence of VPS infection in cases with VPS inserted is known to be between 6.5-23.5%. The aim of this study is to evaluate the treatment and complications relating to VPS surgery infections in pediatric patients with hydrocephalus. Material and Methods: Patients between January 2011 and January 2013 with VPS inserted for hydrocephalus and complications relating to infections after surgical intervention were included in the study. The patient files were retrospectively investigated and analyzed. Patients were evaluated based on demographic characteristics, etiology of hydrocephalus, date of shunt insertion, operation notes from the VPS insertion operation, microbiological and Araştırma Makalesi / Research Article 72 Cilt/Volume 40 Yıl/Year 2015 Ventriküloperitoneal Şant Enfeksiyonları biochemical test results on CSF samples after diagnosis of VPS infection, surgical intervention for treatment, antibiotics administered and duration of antibiotic use. Results: Thirty-five patients monitored for VPS infection diagnosis between the ages of 3 days and 16 years were evaluated. In the 35 patients monitored for VPS infection diagnosis 19 had growth in cerebrospinal fluid (CSF) while 17 patients had no growth in CSF but inflammatory findings were present. The most frequently isolated effective pathogens were coagulase-negative staphylococci (78%). Other microorganisms isolated in the CSF of patients were Staphylococcus aureus, Enterococcus feacalis, Enterococcus gallinarium, Pseudomonas stutzeri, Candida albicans, Streptococcus mitis and ESBL (-) Klebsiella pneumonia. While one patient died during treatment, 34 patients were successfully discharged. Conclusion: We believe that early administration of antibiotic treatment and removal of the infected shunt are of vital importance.

References

  • Davis SE, Levy ML, McComb JG, Masri-Lavine L. Does age or other factors influence the incidence of ventriculoperitoneal shunt infections? Pediatr Neurosurg. 1999;30:253-7.
  • Tuan TJ, Thorell EA, Hamblett NM, Kestle JR, Rosenfeld M, Simon TD. Treatment and microbiology of repeated cerebrospinal fluid shunt infections in children. Pediatr Infect Dis J. 2011;30:731-5.
  • and future. Acta Neurochir (Wien). 1992;116:155-60.
  • Amacher AL, Wellington J. Infantile hydrocephalus: long-term results of surgical therapy. Childs Brain. 1984;11:217-29.
  • Borgbjerg BM, Gjerris F, Albeck MJ, Borgesen SE. Risk of infection after cerebrospinal fluid shunt: an analysis of 884 first-time shunts. Acta Neurochir (Wien ). 1995;136:1-7.
  • Cochrane DD, Kestle JR. The influence of surgical operative experience on the duration of first ventriculoperitoneal shunt function and infection. Pediatr Neurosurg. 2003;38:295-301.
  • Di RC, Marchese E, Velardi F. A survey of the first complication of newly implanted CSF shunt devices for the treatment of nontumoral hydrocephalus. Cooperative survey of the 1991-1992 Education Committee of the ISPN. Childs Nerv Syst. 1994;10:321-7.
  • Frykberg T, Olden L. Infection as a cause of peritoneal catheter dysfunction in ventriculo- peritoneal shunting in children. Z Kinderchir 1983;38:84-6.
  • Kestle J, Drake J, Milner R, Sainte-Rose C, Cinalli G, Boop F, et al. Long-term follow-up data from the Shunt Design Trial. Pediatr Neurosurg. 2000;33:230- 6.
  • Vinchon M, Dhellemmes P. Cerebrospinal fluid shunt infection: risk factors and long-term follow-up. Childs Nerv Syst. 2006;22:692-7.
  • Kestle JR, Garton HJ, Whitehead WE, Drake JM, Kulkarni AV, Cochrane DD, et al. Management of shunt infections: a multicenter pilot study. J Neurosurg. 2006;105:177-81.
  • Dallacasa P, Dappozzo A, Galassi E, Sandri F, Cocchi G, Masi M. Cerebrospinal fluid shunt infections in infants. Childs Nerv Syst. 1995;11:643-8.
  • Kulkarni AV, Drake JM, Lamberti-Pasculli M. Cerebrospinal fluid shunt infection: a prospective study of risk factors. J Neurosurg. 2001;94:195-201.
  • Walters BC, Hoffman HJ, Hendrick EB, Humphreys RP. Cerebrospinal fluid shunt infection. Influences on initial management and subsequent outcome. J Neurosurg. 1984;60:1014-21.
  • Reddy GK, Bollam P, Caldito G. Ventriculoperitoneal shunt surgery and the risk of shunt infection in patients with hydrocephalus: long-term single institution experience. World Neurosurg. 2012;78:155-63.
  • Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis. 2004;39:1267-84.
  • Lee JK, Seok JY, Lee JH, Choi EH, Phi JH, Kim SK, et al. Incidence and risk factors of ventriculoperitoneal shunt infections in children: a study of 333 consecutive shunts in 6 years. J Korean Med Sci. 2012;27:1563-8.
  • Stamos JK, Kaufman BA, Yogev R. Ventriculoperitoneal shunt infections with gram- negative bacteria. Neurosurgery. 1993;33:858-62.
  • Brook I. Meningitis and shunt infection caused by anaerobic bacteria in children. Pediatr Neurol. 2002;26:99-105.
  • Chiou CC, Wong TT, Lin HH, Hwang B, Tang RB, Wu KG, et al. Fungal infection of ventriculoperitoneal shunts in children. Clin Infect Dis. 1994;19:1049-53.
  • McClinton D, Carraccio C, Englander R. Predictors of ventriculoperitoneal shunt pathology. Pediatr Infect Dis J. 2001;20:593-7.
  • Anderson EJ, Yogev R. A rational approach to the management of ventricular shunt infections. Pediatr Infect Dis .J 2005;24:557-8.
  • Key CB, Rothrock SG, Falk JL. Cerebrospinal fluid shunt complications: an emergency medicine perspective. Pediatr Emerg Care. 1995;11:265-73.
  • Tatara R, Imai H. Serum C-reactive protein in the differential diagnosis of childhood meningitis. Pediatr Int. 2000;42:541-6.
  • Sormunen P, Kallio MJ, Kilpi T, Peltola H. C-reactive protein is useful in distinguishing Gram stain-negative bacterial meningitis from viral meningitis in children. J Pediatr. 1999;134:725-9.
  • Dettenkofer M, Forster DH, Ebner W, Gastmeier P, Ruden H, Daschner FD. The practice of perioperative antibiotic prophylaxis in eight German hospitals. Infection. 2002;30:164-7.
  • Ebner W, Forster DH, Ruden H, Daschner F. [Evidence-based recommendations for perioperative antibiotic prophylaxis]. Chirurg. 2000;71:912-7.
  • Whitehead WE, Kestle JR. The treatment of cerebrospinal fluid shunt infections. Results from a practice survey of the American Society of Pediatric Neurosurgeons. Pediatr Neurosurg. 2001;35:205-10.
  • Beer R, Engelhardt KW, Pfausler B, Broessner G, Helbok R, Lackner P, et al. Pharmacokinetics of intravenous linezolid in cerebrospinal fluid and plasma in neurointensive care patients with staphylococcal ventriculitis associated with external ventricular drains. Antimicrob Agents Chemother. 2007;51:379-82.
  • Prusseit J, Simon M, von der BC, Heep A, Molitor E, Volz S, et al. Epidemiology, prevention and management of ventriculoperitoneal shunt infections in children. Pediatr Neurosurg. 2009;45:325-36.

Çocuklarda Ventriküloperitoneal Şant Enfeksiyonları ve Tedavisi

Year 2015, Volume: 40 Issue: 1, 72 - 79, 09.09.2015
https://doi.org/10.17826/cutf.09848

Abstract

Amaç: VPS cerrahisinin en önemli komplikasyonu cerrahi sonrası dönemde gelişen santral sinir sistemi enfeksiyonudur. VPS enfeksiyonlarının insidansının VPS takılan olguların tümünde %6.5-23.5 oranında olduğu bildirilmektedir. Bu çalışmanın amacı hidrosefalili çocuk hastalarda VPS ameliyatlarının enfeksiyon ilişkili komplikasyonlarını ve tedavilerini değerlendirmektir. Materyal ve Metod: Ocak 2011- Ocak 2013 yılları arasında hidrosefali nedeniyle VPS takılan ve cerrahi girişim sonrası enfeksiyon ilişkili komplikasyon gelişen hastalar çalışmaya alındı. Hastaların dosyaları retrospektif olarak incelendi ve analiz edildi. Hastalara ait demografik özellikler, hidrosefali etyolojisi, şant takılma tarihi, VPS takılmasına ait operasyon notları, VPS enfeksiyonu tanısı konulduktan sonraki BOS örneklerine ait mikrobiyolojik ve biyokimyasal testlerin sonuçları, tedaviye yönelik olarak yapılan cerrahi müdahele ve verilen antibiyotik türleri, antibiyotiklerin kullanma süreleri değerlendirildi. Bulgular: Yaşları üç gün ile 16 yaş arasında değişen, VPS enfeksiyonu tanısı ile izlenen 35 hasta değerlendirildi. VPS enfeksiyonu tanısı ile izleme alınan 35 hastanın 19’unda BOS kültüründe üreme olurken, 17 hastanın BOS kültüründe üreme olmaksızın inflamasyon bulguları mevcuttu. En sık izole edilen etken patojen coagulase negative Staphylococci (%78) idi. Hastaların BOS’larından izole edilen diğer mikroorganizmalar; Staphylococcus aureus, Enterococcus feacalis, Enterococcus gallinarium, Pseudomonas stutzeri, Candida albicans, Streptococcus mitis ve ESBL (-) Klebsiella pneumonia idi. Tedavi sırasında bir hasta kaybedilirken, 34 hasta şifa ile taburcu edildi. Sonuç: VPS enfeksiyonların da erken antibiyotik tedavisi verilmesinin ve enfekte şantın çıkarılmasının hayati öneme sahip olduğunu düşünmekteyiz.

References

  • Davis SE, Levy ML, McComb JG, Masri-Lavine L. Does age or other factors influence the incidence of ventriculoperitoneal shunt infections? Pediatr Neurosurg. 1999;30:253-7.
  • Tuan TJ, Thorell EA, Hamblett NM, Kestle JR, Rosenfeld M, Simon TD. Treatment and microbiology of repeated cerebrospinal fluid shunt infections in children. Pediatr Infect Dis J. 2011;30:731-5.
  • and future. Acta Neurochir (Wien). 1992;116:155-60.
  • Amacher AL, Wellington J. Infantile hydrocephalus: long-term results of surgical therapy. Childs Brain. 1984;11:217-29.
  • Borgbjerg BM, Gjerris F, Albeck MJ, Borgesen SE. Risk of infection after cerebrospinal fluid shunt: an analysis of 884 first-time shunts. Acta Neurochir (Wien ). 1995;136:1-7.
  • Cochrane DD, Kestle JR. The influence of surgical operative experience on the duration of first ventriculoperitoneal shunt function and infection. Pediatr Neurosurg. 2003;38:295-301.
  • Di RC, Marchese E, Velardi F. A survey of the first complication of newly implanted CSF shunt devices for the treatment of nontumoral hydrocephalus. Cooperative survey of the 1991-1992 Education Committee of the ISPN. Childs Nerv Syst. 1994;10:321-7.
  • Frykberg T, Olden L. Infection as a cause of peritoneal catheter dysfunction in ventriculo- peritoneal shunting in children. Z Kinderchir 1983;38:84-6.
  • Kestle J, Drake J, Milner R, Sainte-Rose C, Cinalli G, Boop F, et al. Long-term follow-up data from the Shunt Design Trial. Pediatr Neurosurg. 2000;33:230- 6.
  • Vinchon M, Dhellemmes P. Cerebrospinal fluid shunt infection: risk factors and long-term follow-up. Childs Nerv Syst. 2006;22:692-7.
  • Kestle JR, Garton HJ, Whitehead WE, Drake JM, Kulkarni AV, Cochrane DD, et al. Management of shunt infections: a multicenter pilot study. J Neurosurg. 2006;105:177-81.
  • Dallacasa P, Dappozzo A, Galassi E, Sandri F, Cocchi G, Masi M. Cerebrospinal fluid shunt infections in infants. Childs Nerv Syst. 1995;11:643-8.
  • Kulkarni AV, Drake JM, Lamberti-Pasculli M. Cerebrospinal fluid shunt infection: a prospective study of risk factors. J Neurosurg. 2001;94:195-201.
  • Walters BC, Hoffman HJ, Hendrick EB, Humphreys RP. Cerebrospinal fluid shunt infection. Influences on initial management and subsequent outcome. J Neurosurg. 1984;60:1014-21.
  • Reddy GK, Bollam P, Caldito G. Ventriculoperitoneal shunt surgery and the risk of shunt infection in patients with hydrocephalus: long-term single institution experience. World Neurosurg. 2012;78:155-63.
  • Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis. 2004;39:1267-84.
  • Lee JK, Seok JY, Lee JH, Choi EH, Phi JH, Kim SK, et al. Incidence and risk factors of ventriculoperitoneal shunt infections in children: a study of 333 consecutive shunts in 6 years. J Korean Med Sci. 2012;27:1563-8.
  • Stamos JK, Kaufman BA, Yogev R. Ventriculoperitoneal shunt infections with gram- negative bacteria. Neurosurgery. 1993;33:858-62.
  • Brook I. Meningitis and shunt infection caused by anaerobic bacteria in children. Pediatr Neurol. 2002;26:99-105.
  • Chiou CC, Wong TT, Lin HH, Hwang B, Tang RB, Wu KG, et al. Fungal infection of ventriculoperitoneal shunts in children. Clin Infect Dis. 1994;19:1049-53.
  • McClinton D, Carraccio C, Englander R. Predictors of ventriculoperitoneal shunt pathology. Pediatr Infect Dis J. 2001;20:593-7.
  • Anderson EJ, Yogev R. A rational approach to the management of ventricular shunt infections. Pediatr Infect Dis .J 2005;24:557-8.
  • Key CB, Rothrock SG, Falk JL. Cerebrospinal fluid shunt complications: an emergency medicine perspective. Pediatr Emerg Care. 1995;11:265-73.
  • Tatara R, Imai H. Serum C-reactive protein in the differential diagnosis of childhood meningitis. Pediatr Int. 2000;42:541-6.
  • Sormunen P, Kallio MJ, Kilpi T, Peltola H. C-reactive protein is useful in distinguishing Gram stain-negative bacterial meningitis from viral meningitis in children. J Pediatr. 1999;134:725-9.
  • Dettenkofer M, Forster DH, Ebner W, Gastmeier P, Ruden H, Daschner FD. The practice of perioperative antibiotic prophylaxis in eight German hospitals. Infection. 2002;30:164-7.
  • Ebner W, Forster DH, Ruden H, Daschner F. [Evidence-based recommendations for perioperative antibiotic prophylaxis]. Chirurg. 2000;71:912-7.
  • Whitehead WE, Kestle JR. The treatment of cerebrospinal fluid shunt infections. Results from a practice survey of the American Society of Pediatric Neurosurgeons. Pediatr Neurosurg. 2001;35:205-10.
  • Beer R, Engelhardt KW, Pfausler B, Broessner G, Helbok R, Lackner P, et al. Pharmacokinetics of intravenous linezolid in cerebrospinal fluid and plasma in neurointensive care patients with staphylococcal ventriculitis associated with external ventricular drains. Antimicrob Agents Chemother. 2007;51:379-82.
  • Prusseit J, Simon M, von der BC, Heep A, Molitor E, Volz S, et al. Epidemiology, prevention and management of ventriculoperitoneal shunt infections in children. Pediatr Neurosurg. 2009;45:325-36.
There are 30 citations in total.

Details

Primary Language English
Journal Section Research
Authors

Eren Çağan This is me

Ahmet Soysal This is me

Aşkın Şeker This is me

Mustafa Şeker This is me

Publication Date September 9, 2015
Published in Issue Year 2015 Volume: 40 Issue: 1

Cite

MLA Çağan, Eren et al. “Ventriculoperitoneal Shunt Infection and Treatment in Children”. Cukurova Medical Journal, vol. 40, no. 1, 2015, pp. 72-79, doi:10.17826/cutf.09848.