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Ventriculoperitoneal shunt infection
From WikEM
Contents
Background
- Occurrence
- 50% within first 2 weeks of placement
- 70% within 2 months of placement
- 80% within 6 months of placement
- 10% present >1 year after surgery
Types
- External Infection
- Involve the subcutaneous tract around the shunt
- Internal Infection
- Involves the shunt and CSF contained within the shunt
Bacteriology
- 50% of cases caused by S. epidermidis
- Also caused by S. aureus, Gram-negatives, anaerobes
Clinical Features
- Internal Infection
- Mental status changes, headache, nausea and vomiting, irritability
- Neck stiffness (33% of patients)
- Fever is often absent
- Abdominal pain (VP shunt)
- External Infection
- Swelling, erythema, tenderness along site of shunt tubing
Differential Diagnosis
Ventriculoperitoneal shunt problems
- Ventriculoperitoneal shunt obstruction
- Ventriculoperitoneal shunt overdrainage (Slit Ventricle Syndrome)
- Ventriculoperitoneal shunt infection
- Ventriculoperitoneal shunt mechanical failure
Evaluation
- Shunt tap (only done by neurosurgeon unless critically high ICP and no surgeon available)
- LP often misses CSF shunt infections and has no role when shunt infection is suspected
- Imaging
- Useful to exclude mechanical shunt malfunction (often coexists with infection)
Management
- Emergent neurosurgical consultation and admission
- Antibiotics
Pediatric
- Empiric therapy: Vancomycin AND Cefotaxime 200 mg/kg/day IV div Q6 OR ceftriaxone 100 mg/kg/day IV div Q12-24
- Always involved neurosurgery in management
- Tailor antimicrobial therapy to culture results
Disposition
- Admit