Affiliation:
1. Department of Medical Microbiology, Frenchay Hospital, Bristol, United Kingdom
2. Department of Neurosurgery, Frenchay Hospital, Bristol, United Kingdom
Abstract
AbstractOBJECTIVE:In patients with cerebrospinal fluid (CSF) shunt infection, removal of the shunt and antibiotic administration is the current standard of care. In 1986, we developed a protocol for the conservative management of patients with infected but functioning shunts. Treatment was based on the administration of a combination of intraventricular and systemic antibiotics. Intraventricular antibiotics were instilled via a separate access device. The purpose of this report is to describe our experience with this therapeutic intervention.METHODS:An observational study of all patients treated for CSF shunt infection between 1986 and 2003 was undertaken. Cure was defined by sterile CSF after completion of therapy and sterile shunt components at next revision or long-term freedom from recurrent infection (follow-up period, 6–88 mo).RESULTS:In total, 43 of 122 patients with CSF shunt infections were treated conservatively according to our protocol. Overall, 84% of these patients were cured, with a 92% success rate for patients with infections caused by bacteria other than Staphylococcus aureus. This included 30 coagulase-negative staphylococcal infections, of which two were treatment failures. We abandoned conservative treatment of patients with Staphylococcus aureus infections after early experience demonstrated that the success rate (four treatment failures in seven patients) was markedly lower than that for other pathogens. During the treatment and follow-up periods, there were three deaths, two of which were unrelated to shunt infection; treatment failure could not be completely excluded in the remaining patient. There was no toxicity related to intraventricular antibiotic administration. The incidence of shunt blockage among patients who were treated conservatively was not significantly different from that among a large cohort of patients with uninfected shunts. Ten patients received part of their courses of treatment as outpatients.CONCLUSION:The success rate of conservative management of patients with CSF shunt infections caused by coagulase-negative staphylococci is comparable with those in the published literature for patients treated conventionally. This form of management avoids surgical intervention, with its attendant risks, and is safe.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Clinical Neurology,Surgery
Reference47 articles.
1. Routine placement of a ventricular reservoir at endoscopic third ventriculostomy;Aquilina;Neurosurgery,2003
2. The use of intraventricular vancomycin in the treatment of CSF shunt-associated ventriculitis;Bayston,1984
3. Excessive production of mucoid substance in staphylococcus SIIA: A possible factor in colonisation of Holter shunts;Bayston;Dev Med Child Neurol Suppl,1972
4. Prospective study of infections in indwelling central venous catheters using quantitative blood cultures;Benezra;Am J Med,1988
5. Trends in the treatment of orthopaedic prosthetic infections;Bernard;J Antimicrob Chemother,2004
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