Jpn. J. Infect. Dis., 57, 44-48, 2004

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Original Article

Infection of Cerebrospinal Fluid Shunts: Causative Pathogens, Clinical Features, and Outcomes

Kuo-Wei Wang, Wen-Neng Chang1, Teng-Yuan Shih , Chi-Ren Huang1, Nai-Wen Tsai1, Chen-Sheng Chang2, Yao-Chung Chuang2, Po-Chou Liliang3, Thung-Ming Su, Cheng-Shyuan Rau , Yu-Duan Tsai3, Ben-Chung Cheng4, Pi-Lien Hung5, Chin-Jung Chang6, Cheng-Hsien Lu1*

Department of Neurosurgery, 1Neurology, 4Medicine, and 5Pediatric Neurology, Chang Gung Memorial Hospital-Kaohsiung, 2Department of Neurology and 3Neurosurgery, I-Shou University Hospital, Kaohsiung, and 6Department of Pediatrics, Buddhist Dalin Tzu Chi General Hospital, Chia-Yi, Taiwan

(Received November 13, 2003. Accepted March 4, 2004)

*Corresponding author: Mailing address: Department of Neurology, Chang Gung Memorial Hospital, 123 Ta Pei Road, Niao Sung Hsiang, Kaohsiung Hsien, Taiwan. Tel: +886-7-731-7123 ext. 2286, Fax: +886-7-731-8762, E-mail: chlu99@ms44.url.com.tw



SUMMARY: This retrospective chart review describes the clinical features, pathogens, and outcomes of 46 patients with cerebrospinal fluid (CSF) shunt infections collected over 16 years. The overall CSF shunt infection rate was 2.1%, broken down into 1.7 and 9.3% in adult and pediatric groups, respectively. Fever and progressive consciousness disturbance were the most clinical features in the adult patient group, whereas disturbance of consciousness and abdominal symptoms and signs were the two most common clinical features in the pediatric patient group. The most frequently isolated microorganisms were of the Staphylococcus spp., including Staphylococcus aureus and coagulase negative Staphylococcus, which accounted for 47% of the episodes. Furtheremore, increases in polymicrobial and Gram-negative bacilli infections were observed in our study. Due to the high proportion of oxacillin-resistant Staphylococcus spp. and polymicrobial infections, we recommend initial empirical antibiotics with both vancomycin and a third-generation cephalosporin for cases in which the causative bacteria has not been identified or for which the results of antimicrobial susceptibility tests are not available. For patients who develop smoldering fevers, progressive disturbed consciousness, seizures, or abdominal fullness after ventriculoperitoneal shunt procedures, CSF shunt infections should be suspected. Although some infections have been managed successfully with antimicrobial therapy alone, the timely use of appropriate antibiotics according to antimicrobial susceptibility testing and the removal of the shunt apparatus are essential for successful treatment.

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