부산대학교 도서관

Background: Infections are a common and serious complication of ventricular shunts that can lead to significant mortality and morbidity. Treatment consists of surgical and antimicrobial therapy, but there is a lack of evidence regarding optimal management. We therefore aimed to analyse the current practice and patient outcomes within a large tertiary referral centre. Methods: We identified cases of infection in ventriculoperitoneal shunts from January 2000 until April 2015 in our institution. All patients were under 18 years at the time of infection. Clinical, microbiological and radiological data were collected with the use of a standardised proforma. Non-parametric tests were used for statistical analysis. Results: There were 92 episodes of infection in 65 patients. The most common microorganisms were coagulase-negative staphylococci (47%), followed by Staphylococcus aureus (16%). Surgical treatment included shunt externalisation (15%) and complete removal (67%). Antibiotics were given in 97% of the patients in addition to surgery. Vancomycin, linezolid, cefotaxime, meropenem and rifampicin were used most frequently. The median duration of antibiotic treatment was 18 days (IQR 14-25 days). Two patients died from consequences of a shunt infection and seven had recurrent infection. Conclusions: It would be beneficial to develop a guideline for recognition and treatment of shunt infections. Complete removal of the shunt and placement of an EVD seems the safest surgical treatment. Empirical antibiotic treatment should be started as soon as possible. A combination of linezolid and ceftriaxone would be appropriate first line antibiotics, with meropenem as second line. Antibiotics can be rationalised once the CSF culture results are known.