Abstract
It is now recognised that infections in CSF shunts and external ventricular drains (EVDs) are biofilm infections, and the scientific basis of these infections is better understood. Infection rates in shunts have now fallen but remain unacceptably high. There is an increase in infections due to multi-drug-resistant bacteria in EVDs. Reliance on antimicrobial prophylaxis has potential lifethreatening consequences and safer more effective measures are available. These consist of well-founded “bundles” or surgical protocols that have been shown to reduce infection by application of well known but not universally applied principles. New developments in antimicrobial technology have now been shown to be clinically effective and have reduced healthcare costs. The reduction in antibiotic use has led to fewer adverse effects. Problems with multidrug resistance in EVD infections remain and technology to address these has been developed but is not yet clinically available.