Management and Outcome Predictors of Pediatric Cerebrospinal Fluid Shunt Infections

Youssef, Essam Mohamed; Rashed, Magdy Elsayed; Elsayed, Belal Mohamed; El Sheikh, Magdy Omar

doi:10.21608/ejhm.2022.274795

Management and Outcome Predictors of Pediatric Cerebrospinal Fluid Shunt Infections

Document Type : Original Article

Authors

10.21608/ejhm.2022.274795

Abstract

Background: Cerebrospinal fluidShunts can cause a number of complications, the most prevalent one is infection. Infection causes significant morbidity, particularly in pediatrics more than adults, and its management is extremely challenging for healthcare systems.
Objective: This study aimedto determine the outcome predictors of pediatric shunt infections to achieve the best management plans.
Patients and methods: A prospective observational cohort study was conducted in Intensive Care Unit of Neurosurgery Department, Zagazig University Hospitals and Kafr EL-Sheikh University Hospitals. 40 pediatric patients with proved CSF shunt infection were included. All patients were subjected to clinical, laboratory and radiological assessment.
Results: Patients with CSF shunt–associated infections often presented early after shunt placement or revision with nonspecific clinical manifestations (especially fever) and abnormal CSF values. CSF sampling is preferred from the valve, where leukocyte counts and the rate of culture positivity were highest. Shunt-associated infections were caused predominantly by gram-positive skin flora. Some cases were caused by Acinetobacter species that are resistant to usually used antibiotics. Some of them improved after administration of antibiotics both systemically and intraventricularly. Outcome is significantly affected by different parameters that have been shown in our study.
Conclusion: Promising results are obtained by early removal of the shunt hardware accompanied by appropriate antibiotic therapy until CSF studies turn negative, followed by shunt replacement. Post-infectious hydrocephalus was the most common cause in our study with bad outcome. Recurrent infections occurred more commonly in children with; congenital anomalies, preterm, with intraventricular hemorrhage, with systemic and local illness, and usually had unfavorable outcomes.

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