Factors Related with Infection after Cerebrospinal Fluid Shunt and Nursing Interventions / 中国康复理论与实践

@# Objective To explore the factors related with the infection after cerebrospinal fluid shunt (CFS) and nursing interventions.Methods 115 patients receiving CFS were reviewed. Results From November, 2009 to December, 2011, infection was found in 11 of 60 patients receiving CFS (18.3%). After intensive intervention, no infected case was found from January, 2012 to August, 2013 in 55 cases receiving CFS. Factors related with the infection included non-antibiotic-soaked shunt, non-laminar flow operating room, one-glove surgical procedure, and too many persons in the operating room. Conclusion Intensive nursing interventions can prevent the infection after CFS.

Acute Shunt Malfunction Caused by Percutaneous Endoscopic Gastrostomy without Shunt Infection

Percutaneous endoscopic gastrostomy tube placement is often performed in patients with a ventriculoperitoneal shunt and it has been accepted as a safe procedure. The authors report a case of a 50-year-old male who developed acute exacerbation of the hydrocephalus immediately after the percutaneous endoscopic gastrostomy tube placement without any signs of shunt infection, which has not been reported until now. After revision of the intraperitoneal shunt catheter, the sizes of the intracranial ventricles were normalized.

Increased Vascular Endothelial Growth Factor in the Ventricular Cerebrospinal Fluid as a Predictive Marker for Subsequent Ventriculoperitoneal Shunt Infection : A Comparison Study among Hydrocephalic Patients

OBJECTIVE: The aim of this study is to determine the association between the cerebrospinal fluid (CSF) biomarkers and inflammation, and the predictive value of these CSF biomarkers for subsequent shunt associated infection. METHODS: We obtained CSF samples from the patients with hydrocephalus during ventriculoperitoneal (VP) shunt operations. Twenty-two patients were enrolled for this study and divided into 3 groups: subarachnoid hemorrhage (SAH)-induced hydrocephalus, idiopathic normal pressure hydrocephalus (INPH) and hydrocephalus with a subsequent shunt infection. We analyzed the transforming growth factor-beta1, tumor necrosis factor-alpha, vascular endothelial growth factor (VEGF) and total tau in the CSF by performing enzyme-linked immunosorbent assay. The subsequent development of shunt infection was confirmed by the clinical presentations, the CSF parameters and CSF culture from the shunt devices. RESULTS: The mean VEGF concentration (+/-standard deviation) in the CSF of the SAH-induced hydrocephalus, INPH and shunt infection groups was 236+/-138, 237+/-80 and 627+/-391 pg/mL, respectively. There was a significant difference among the three groups (p=0.01). Between the SAH-induced hydrocephalus and infection groups and between the INPH and infection groups, there was a significant difference of the VEGF levels (p<0.01). However, the other marker levels did not differ among them. CONCLUSION: The present study showed that only the CSF VEGF levels are associated with the subsequent development of shunt infection. Our results suggest that increased CSF VEGF could provide a good condition for bacteria that are introduced at the time of surgery to grow in the brain, rather than reflecting a sequel of bacterial infection before VP shunt.

A case of Corynebacterium xerosis Infection in Cerebrospinal Fluid and Ventriculoperitoneal Shunt / 대한임상미생물학회지

Corynebacterium xerosis is a normal flora of the skin, mucous membrane and gastrointestinal tract. Although not usually considered to be a pathogen, it occasionally causes serious infections in immunocompromised hosts. We report a case of a shunt infection by C.xerosis developed in a 58-year-old woman following the insertion of a ventriculoperitoneal shunt. The organism was also isolated from the cerebrospinal fluid and blood. The isolate was resistant to most of the antibiotics tested except for vancomycin. However, in spite of treatment with vancomycin, the patient was expired after 5 months.

Post-Shunt Infection in Hydrocephalus

Shunt infection remains one of the most frequent and disabling neurosurgical complications. We reviewed the medical records of 40 patients who between 1989 and 1997 underwent CSF shunt surgery involving a total of 48 procedures. Infection occured in six of the 40 patients and secondary postoperative infection in two; i.e. in eight of 48 procedures(16.7%); the microorganisms involved were not always isolated, though in all cases, clinical symptoms were detected. Most episodes occured within 6 months of the last shunt operation and patients under one year old are greater risk of infection than those who are older. To prevent such infection careful preoperative surgical planning is mandatory.

Candida Albicans Shunt Infection: Case Report

Two patients of shunt infection caused by Candida albicans are presented. They were low birth weight premature babies with prolonged antibiotic therapy for the neonatal pneumonia. They were diagnosed as posthemorrhagic and congenital hydrocephalus and underwent ventriculoperitoneal shunt(VPS). Postoperatively fever and setting sun eyes developed and anterior fontanel became tense and bulging within two months after VPS. One patient was documented as C. albicans shunt infection by facteriological study and scanning electron microscopy(SEM) and the other patient by bacteriological study only. The authors controlled the C. albicans shunt infection by removal of shunt device and intravenous Amphotericin B. In C. albicans shunt infection, it is important to remove the infected shunt device immediately after the diagnosis and bacteriological study is diagnostic, but SEM plays a role in the demonstration of the fungal elements in the shunt device.