Management of ventriculo-peritoneal shunt infections

ABSTRACT

To analyze etiology, clinical features, pathogens, mortality and morbidity, and modalities of treatment for ventriculo-peritoneal [VP] shunt infections. Descriptive case series. Study was carried out in the department of Neurosurgery, Foundation University Medical College Rawalpindi, from June 2003 to June 2008. The record of 5 year period was reviewed. The data were evaluated for etiology of hydrocephalus, age, clinical features, microbiological parameters, management and clinical outcome of VP shunt infections. A total of 149 patients were operated for ventriculo-peritoneal shunt. Majority [n 128 - 86%] were below the age of 5 years. Twenty-one [14%] of the operated patients were admitted with symptoms of shunt infection. Four [19%] of the infected patients had throat infection/gastroenteritis rather than shunt infection. Six [29%] patients were treated conservatively with intravenous antibiotics. Eleven [52%] of the infected patients had removal of shunt and insertion of external ventricular drain [EVD] with periodic CSF sampling and culture sensitivity [CS] and delayed shunt replacement. Five [3.3%] of VP shunt patients died with shunt infection and septicemia. Commonest causative microorganism identified were staphylococcus epidermidis, staphylococcus aureus and gram negative bacilli. The most common bacteria isolated were gram positive organisms. In cases with VP shunt infection it is essential to remove VP shunt and start systemic antibiotics