Evaluation of Shunt-Related Ventriculitis in Infants

Yıl 2024, Cilt: 51 Sayı: 3, 377 - 384, 19.09.2024

Abdurrahman Arpa , Pınar Aydın Ozturk , Muhammet Asena

https://doi.org/10.5798/dicletip.1552527

Öz

Aims: Shunt-related infections are resistant to antibiotics. This study examined patients aged under two years after ventriculitis. It is the first study on ventriculitis developed in a completely closed system (without skin defect infection, or puncture history), evaluating infants only.
Method: The study included 13 subjects (four females) with ventriculitis who had undergone surgery for hydrocephalus during the neonatal period and were monitored for shunt infection, evaluating certain parameters.
Results: Ventriculitis developed on an average of 2.8 months after surgery. The most common causes of hydrocephalus were spina bifida and intraventricular hemorrhage. Bacteria grown in culture included Staphylococcus epidermidis, Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Serratia marcescens. Seven (53.8%) patients were treated without complications. Among other patients, three (23.1%) developed multilocular cystic hydrocephalus and three (23.1%) exhibited decreased cerebrospinal fluid production and did not require shunting.
Conclusions: Patients receiving intraventricular therapy showed no complications, warranting further studies on early intraventricular therapy. In the presence of gram-negative bacterial growth, cerebrospinal fluid production may decrease and affected patients do not require shunts.

Anahtar Kelimeler

Ventriculitis, shunt infections, shunt related ventriculitis

Kaynakça

• 1.Kiyak V, Cansaran S. A Rare PostoperativeComplication in a Pediatric Hydrocephalus Case:Migration of the Ventriculoperitoneal Shunt CatheterInto the Scrotal Hernia Sac. Turkiye Klinikleri J CaseRep. 2023;31(3):101-104.
• 2.Beer R, Lackner P, Pfausler B, E Schmutzhard.Nosocomial ventriculitis and meningitis in neurocritical care patients. J Neurol. 2208;255:1617–1624 doi: 10.1007/s00415-008-0059-8.
• 3.Laborada G, Cruz F, Nesin M. Serial cytokine profilesin shunt related ventriculitis treated withintraventricular vancomycin. Chemotherapy.2005;51:363–365 doi: 10.1159/000088963.
• 4.Tabuchi S, Kadowaki M. Neuroendoscopic surgeryfor ventriculitis and hydrocephalus after shuntinfection and malfunction: preliminary report of a new strategy. Asian J Endosc Surg. 2015;8:180–184 doi:10.1111/ases.12162.
• 5.Ó Maoldomhnaigh C, Drew RJ, Gavin P, Cafferkey M,Butler KM. 2016. Invasive meningococcal disease inchildren in Ireland, 2001-2011. Arch Dis Child.2016.;101:1125–1129 doi: 10.1136/archdischild-2015-310215.
• 6.Peros T, van Schuppen J, Bohte A, et al. Neonatalbacterial meningitis versus ventriculitis: a cohort-based overview of clinical characteristics,microbiology and imaging. Eur J Pediatr. 2020;179(12):1969-1977 doi: 10.1007/s00431-020-03723-3.
• 7.Wang F, Yao XY, Zou ZR, Yu HL, Sun T. Managementof pyogenic cerebral ventriculitis by neuroendoscopicsurgery. World Neurosurg. 2017;98:6–13 doi:10.1016/j.wneu.2016.10.103.
• 8.Simon TD, Hall M, Dean JM, Kestle JR, Riva-CambrinJ.Reinfection following initial cerebrospinal fluidshunt infection. J Neurosurg Pediatr. 2010;6:277–285doi: 10.3171/2010.5.PEDS09457. 9.Richard Winn H. Shunt infections and theirtreatments. Gupta N. Youmans Neurological Surgery.Elsevier Saunders. 6th ed. 2012; 2035–2039.
• 10.Kong W, Yin C, Lv Y, et al. Endoscopic ThirdVentriculostomy vs. Ventriculoperitoneal Shunt forObstructive Hydrocephalus: A Meta-Analysis ofRandomized Controlled Trials. Turk Neurosurg.2023;33(6): 960-966 doi: 10.5137/1019-5149.JTN.40204-22.2
• 11.Ersahin Y. Cerebrospinal Fluid Shunt Infections.Ankara: Turkish Neurosurgery. 1999; 9:12–20.
• 12.Simon TD, Butler J, Whitlock KB, et al. 2014. Riskfactors for first cerebrospinal fluid shunt infection:findings from a multi-center prospective cohort study.J Pediatr. 2014;164:1462–1468 doi:10.1016/j.jpeds.2014.02.013
• 13.McGirt MJ, Zaas A, Fuchs HE, et al. Risk factors forpediatric ventriculoperitoneal shunt infection andpredictors of infectious pathogens. Clin Infect Dis.2003;36: 858–862 doi: 10.1086/368191.
• 14.Bayston R, Lari J. A study of the sources of infection in colonized shunts. Dev Med Child Neurol.1974;16:16–22 doi: 10.1111/j.1469-8749.1974.tb03443.x
• 15.Faillace WJ. A no touch technique protocol todiminish cerebrospinal fluid shunt infection. SurgNeurol. 1995; 43(4):344-350 doi: 10.1016/0090-3019(95)80060-t.
• 16.Tunkel AR, Hasbun R, Bhimraj A, et al. 2017.Infectious Diseases Society of America’s clinicalpractice guidelines for healthcare-associatedventriculitis and meningitis. Clin Infect Dis. 64:34–65doi: 10.1093/cid/ciw861.
• 17.Unlu A, Secinti D. 2010. Basic Neurosurgery. Shuntsurgery and complications. Ankara: TurkishNeurosurgery Association Publications 1927–1938.
• 18.Ayhan M, Kalem AK, Hasanoglu I, et al. Intrathecaland Intraventricular Administration of Antibiotics inGram-Negative Nosocomial Meningitis in a ResearchHospital in Turkey. Turk Neurosurg. 2021;31(3):348-354 doi: 10.5137/1019-5149.JTN.29844-20.2.
• 19.Tunkel AR, Hartman BJ, Kaplan SL, et al. Practiceguidelines for the management of bacterial meningitis.Clin Infect Dis. 2004;39:1267–1284. doi:10.1086/425368.
• 20.Breeze RE, McComb JG, Hyman S, Gilles FH. CSFproduction in acute ventriculitis. J Neurosurg.1989;70:619–622 doi: 10.3171/jns.1989.70.4.0619
• 21.Cardia E, Molina D, Abbate F, et al. 1995.Morphological modifications of the choroid plexus in arodent model of acute ventriculitis induced by gramnegative liquoral sepsis. Possible implications in thepathophysiology of hypersecretory hydrocephalus.Childs Nerv Syst. 1995;11:511–516 doi:10.1007/BF00822840.
• 22.Hussain RA, Sajid S, Bhatti I, Leach P. Ventriculo-peritoneal shunt independence following successfultreatment of Gram negative (E coli) ventriculitis: Casereport and review of the literature. Br J Neurosurg.2016;30:459–460 doi:10.3109/02688697.2015.1096908.