Outcome analysis of ventriculoperitoneal shunt surgery in. The bibliographies of retrieved papers were also searched for additional references. Obstruction is the most common cause of vp shunt malfunction requiring surgical shunt revision and may occur at either the proximal or the distal end. Cns shunt infections is a topic covered in the johns hopkins abx guide to view the entire topic, please sign in or purchase a subscription official website of the johns hopkins antibiotic abx, hiv, diabetes, and psychiatry guides, powered by unbound medicine. Hydrocephalus is a common condition accounting for 69,000 hospital discharges each year in the united states. Pdf hydrocephalus is a common entity in neurosurgical practice. Infection rates following initial cerebrospinal fluid shunt placement.
Incidence and risk factors of ventriculoperitoneal shunt. Direct url citations appear in the printed text and are provided in the html and pdf versions of this article on the journals web site. In postsubarachnoid and postmeningitic hydrocephalus, csf samples are useful for cell counts, protein concentration, and to exclude residual infection. These data reflect the shunt infection rate following a single shunt procedure. This hydrocephalus treatment is often complicated by infection of the device with biofilmforming bacteria.
The rate of csf shunt infection varies from 2 to 30% 3, 17, 20, 27. An unusual cause of ventriculoperitoneal shunt infection. They can also be used by facility staff themselves to help guide their practices. The infection rate was calculated and the predisposing cofactors age, gender, cause of the hydrocephalus, previous external ventricle drainage, antibioticimpregnated catheters, the number of revisions, the educational level of the surgeons, and the duration of the operations were. A standardized protocol to reduce cerebrospinal fluid shunt.
The age range was 2 to 71 years, with a median age of 45 years. The use of the aset in the diagnosis of ventriculoatrial. Her study aims to understand the risk factors associated with shunt infection and how shunt infections are being treated. The following list of medications are in some way related to, or used in the treatment of this condition. Cerebrospinal shunt infection in patients receiving antibioticimpregnated versus standard shunts. Session 5 shunt systems and shunt infections hydrocephalus association. Vp shunt infection occurred at a median of 1 month range, 6 days to 8 months after insertion. Pdf postoperative infection in shunts for hydrocephalus. A new hydrocephalus clinical research network protocol to reduce cerebrospinal fluid shunt infection. Ventricular shunts are the most common neurosurgical procedure performed in the united states.
Vp shunt infection with serratia marcescens, a gramnegative anaerobic rod, usually is related to underlying abdominal disease. This article describes the management of the secondencountered pediatric m. Subscribe to medhelp s free newsletter for community support, experience, and guidance. Methods a retrospective, multicentre, registrybased study was conducted based on 10 years data from the uk shunt registry, including primary and revision shunting procedures reported between 2004 and 20.
The audit tools and checklists below are intended to promote cdcrecommended practices for infection prevention in hemodialysis facilities. One of the principal advantages in utilizing the peritoneum for distal catheter placement is the relatively minor damage imparted by a shunt infection 47. The act or process of turning aside or moving to an alternate course. Erythema and tenderness over the subcutaneous shunt tubing are suggestive of csf shunt infection strong, moderate. Typical and mysterious causes for shunt malfunction and how to troubleshoot them duration. Shunt infection is a very common event in the treatment of hydrocephalus, particularly in the pediatric neurosurgery practice. However, shunt infection is a common complication, with a rate ranging from 5. In partnership with cdc, nephrologists transforming dialysis safety external icon ntds has created an online resource which presents core infection prevention and patient safety concepts in a casebased format. Transjugular intrahepatic portosystemic shunt tips is in widespread use for the decompression of portal pressure. However, its critical to understand the signs and symptoms of a shunt failure or the closure of an etv. A standardized protocol to reduce cerebrospinal fluid shunt infection.
The occurrence of other infections during the period of shunt surgery did not influence the infection risk either. In the absence of clinical evidence of a csf shunt infection, routine cultures of shunt components, when shunts are removed for other indications, is not recommended. In both scenarios, an additional parameter with a sensij. Your child will need to stay in hospital while we treat the shunt infection. Experience in shunt management on revision free survival. In order to diagnose a blocked shunt the patient should preferably already have a baseline reading while well with an obviously functioning shunt. Infection can lead to long term cognitive defects, neurological problems, and in some cases death. These devices have dramatically reduced the morbidity and mortality rates associated with hydrocephalus. Interestingly, 43% 921 of patients in the series and 64% 914 of patients with shunt hardware had symptoms of distal infection with peritonitis, pseudocyst or abscess formation. This module, managing infections in an outpatient dialysis facility external icon, is a selfpaced learning tool designed specifically for staff in outpatient hemodialysis facilities. Pdf ventriculoperitoneal shunt infection and appendicitis. Treatment of shunt infections currently includes shunt removal and systemic or intraventricular antibiotic therapy. First, your child will need an operation to remove the infected shunt and put in a temporary drainage device.
A ventriculoperitoneal shunt was placed on the 3rd hospital day figure 1 ac. The shunt became infected and was removed, an admission ct brain scan demonstrated increased ventricular size when compared with a study done 2 yr earlier. Alarming trends vikas kumar 1, ankit s shah 1, daljit singh 1, poonam s loomba 2, hukum singh 1, anita jagetia 1. Shunt infection is also a relatively common complication after shunt. In summary, diagnosis of va shunt infection was typically difficult in our patient but was aided by the aset test, allowing treatment of the shunt infection and precluding development of immune complex disease. Pant institute of postgraduate medical education and research, new delhi, india 2 department of microbiology, g. Antibiotic decisions in the treatment of csf shunt infection include the type and duration of empirical and targeted intravenous antibiotics.
Consciousness issues see alterations of consciousness signs. An infected shunt is treated with surgery and antibiotics. Viral shunting helps maintain diversity within the microbial ecosystem by preventing a single species of marine microbe from. Fever and progressive consciousness disturbance were the most clinical features in the adult.
The mesh terms used for pubmed search text terms for embase included shunt. Common microbial agents for shunt infection include staphylococcus epidermidis, staphylococcus aureus, and candida albicans. The value of creactive protein in the management of shunt. In most cases, the vp shunt is unaffected and left in place after careful perioperative inspection, while the appendix is removed 1,6.
Health, general children analysis diseases causes and theories of causation etiology medicine genetic disorders development and progression hydrocephalus infection. In one study, 344 patients were prospectively randomized to receive three different shunt designs. Antibioticimpregnated catheters for the prevention of csf shunt infections. The remaining 250 patients were free of infection at the end of their 6month. However, when primary shunt infection is the cause of. Reinfection after treatment of first cerebrospinal fluid. Infection of a ventriculoatrial shunt with phenotypically. This article describes treatment of two patients suffering from a vp shunt infection with s. Nevertheless, shunt complications are inevitable during a patients. Cerebrospinal fluid shunt infections in infants springerlink. Presenting symptoms are those of shunt malfunction in up to. Third ventriculostomy for shunt infections in children. Cerebrospinal fluid csf shunt infections remain a significant cause of morbidity and mortality in children with hydrocephalus.
Abdominal complications of ventriculoperitoneal shunts in. Alarming trends vikas kumar 1, ankit s shah 1, daljit singh 1, poonam s loomba 2, hukum singh 1, anita jagetia 1 1 department of neurosurgery, g. I have never had a shunt infection before and i dont have a fever but i have also never had textbook symptoms with any of my problems and i have not had a. Session 5 shunt systems and shunt infections youtube. The shunt and valve revision free survival rates were recorded until july 2017. If a csf shunt or drain is removed for indications other than infection, cultures of shunt or drain components are not recommended strong, moderate. Choose your language the ispn guide to pediatric neurosurgery.
Signs and symptoms of complication when things are going well, its easy to put the concerns about hydrocephalus and the complications that come with it out of your mind. Shunt infections shunt infections are often the result of contamination of proximal end of the shunt with normal skin flora. Causative pathogens, clinical features, and outcomes article pdf available in japanese journal of infectious diseases 572. The median time between shunt procedures to infection was 19 days range, 12,181. A retrospective study of central nervous system shunt. The diagnosis of true shunt infection was based on the typical clinical presentation of a va shunt infection, on the pfge demonstrating that all isolates were identical, and on the favorable response to removal of the infected shunt and institution of appropriate antibiotic therapy. Ventriculoperitoneal vp shunts are used for intracranial pressure management and temporary cerebrospinal fluid csf drainage. Pediatrics volume 103 september, 2005 j neurosurg pediatrics 3 103. Tamara simon discusses her work as the principal investigator for the shunt infection registry for the hydrocephalus clinical research network. Symptoms the presenting symptomatology of shunt infection can vary depending on the age and weight of the patient and can range from subtle shunt malfunction e. These valve types are composed of two siliconmade lea ets, each one having a free. The hydrocephalus association is pleased to announce the launch of our shunt system page on our website. A shunt infection is an infection of a shunt a hole or a small passage which allows movement of fluid from one part of the body to another. Ventriculoperitoneal shunt infection caused by staphylococcus.
Nov 15, 2014 ventricular shunts are the most common neurosurgical procedure performed in the united states. The control group showed a shunt survival rate of 68% at 1 year and 39% at 60 months. Ventriculoperitoneal shunt tube infection and changing. The protocol was prospectively applied at each hcrn center to all children undergoing a shunt insertion or revision procedure. A simple method to reduce infection of ventriculoperitoneal shunts. Objectives to determine current epidemiology and clinical characteristics of cerebrospinal fluid csf shunt surgery, including revisions. As with any implanted foreign body, infection is a serious complication. Ventriculoperitoneal shunt infections p sarguna, v lakshmi abstract central nervous system cns shunt infection is a cause of significant morbidity, causing shunt malfunction and chronic ill health. Shunt infection investigators were intrigued by shunt nephritis through the 1970s, but as the peritoneal shunt became more popular, other issues in shunt infection dominated publications. Forty years of shunt surgery at rigshospitalet, denmark.
Management of ventriculoperitoneal shunt infections in. For each child with 24 months of followup, subsequent csf shunt infections. We use cookies to offer you a better experience, personalize content, tailor advertising, provide social media features, and better understand the use of our services. Original article infections of ventriculoperitoneal shunt and. Sixtyone percent were shunt failure free at 1 year and 47% at 2 years, with a median shunt failure free duration of 656 days. Blood cultures are recommended in patients with susnosis weak, low. The majority of neurosurgical hardware involved was shunt catheters 70% of cases. Ventriculoperitoneal vp shunts drain excess cerebrospinal fluid csf from the cerebral ventricles, commonly to the peritoneal cavity.
The entity of persistent tips infection, also known as endotipsitis is a rare but serious complication of tips insertion. Ventriculoatrial shunts in adults, incidence of infection. Original article infections of ventriculoperitoneal shunt and a simple effective treatment junhui chen, yuhai wang, likun yang, chunlei zhang, weiliang chen, jianqing he, lei chen, jun zhu, peipei li department of neurosurgery, 101st hospital of pla, wuxi 214044, jiangsu, china. Reported series has shown the incidence ranging from 5% to 15%. The audit tools and checklists can be used by individuals when assessing staff practices. However, complications can occur during or after the procedure.
Although there are several therapeutic modalities currently used for the treatment of shunt infections, controversy remains as to which is best given that there has been only one randomized trial comparing their effectiveness. It is the most frequent cause of shunt complications. Although many factors seem to contribute to shunt infection, it is likely that the contamination of the shunt system at the time of surgery is the primary cause but also exposure during cleaning of the surgical wound is the risk. Electricity a lowresistance connection between two. Signs and symptoms of complication hydrocephalus association. A shunt blockage can be very serious as it can lead to an buildup of excess fluid in the brain, which can cause brain damage.
The following steps are used to treat a shunt infection. Shunt infection is a common problem and can occur in up to 27% of patients with a shunt. Learn more about shunt system components, valve mechanisms, most common shunt systems, overdrainage control devices, siphonresistive devices srd and the different symptoms of malfunction andor infection. An independent risk factor for shunt infection was undergoing an operation before the first year of life relative risk 2. There was no difference in shunt failure free duration among the. This study was carried out to evaluate the infection rate associated with cns shunts, assess the frequency of. The aim of the present study was to evaluate the clinical features, pathogens, and outcomes of 22 patients with csf shunt infections collected over. Shunt infection is usually caused by a persons own bacterial organisms and isnt acquired from other children or adults who are ill. Risks associated with any surgical procedure include excessive bleeding and infection.
The authors present a 4yearold male with history of intraventricular hemorrhage resulting in hydrocephalus who presented with an m. Shunt infections and their treatment clinical gate. Shunt failure in the absence of shunt infection is a common occurrence. Shunt infection rates differ among reported studies. If future tests show the level to have risen, this is indicative of shunt infection and prompt intervention can be carried out. Emergency surgery will be needed to replace the malfunctioning shunt. Ventriculoperitoneal shunt tube infection and changing pattern of antibiotic sensitivity in neurosurgery practice. Current epidemiology of cerebrospinal fluid shunt surgery. Shunt free treatment for hydrocephalus 121220 meredith vitrano was a happygolucky 10yearold lacrosse goalie when she got smacked in the head by onetoomany shots. The viral shunt pathway is a mechanism that prevents prokaryotic and eukaryotic marine microbial particulate organic matter pom from migrating up trophic levels by recycling them into dissolved organic matter dom, which can be readily taken up by microorganisms. The hydrocephalus clinical research network quality improvement initiative clinical article.
1127 991 185 607 365 1550 223 1499 145 822 246 1442 295 1422 341 298 775 113 1075 738 562 703 221 1018 366 432 95 1326 1432 596 349 830 1283