Biomaterial Database

Infections of mechanical cerebrospinal fluid shunts. 1988

P Gardner, and T J Leipzig, and M Sadigh

In the United States approximately 16,000 CSF shunt operations are performed annually in the treatment of patients with hydrocephalus. Despite a reduction in the incidence of ventricular shunt infections from previous rates of 15 to 30 percent to rates of 5 to 10 percent in recent years, shunt infections remain the most important complication of the treatment of hydrocephalus and contribute significantly to excess morbidity and mortality. Skin flora organisms such as S. epidermidis, S. aureus, and Proprionibacterium are the most common infecting organisms, and the clustering of approximately 70 percent of infections within the 2-month postoperative period strongly suggests that colonization during shunt placement is an important initiating event. In infections caused by S. epidermidis the production of a glycocalyx slime appears to be an important pathogenetic factor. Clinical manifestations of shunt infections are often non-specific, and fever is the only consistent finding. Therefore, a high index of suspicion and a low threshold for diagnostic evaluation are indicated. Needle aspiration of the shunt reservoir or tubing is the single most reliable diagnostic step and is a procedure remarkably free of complications. The most effective treatment regimen is removal of the infected shunt, treatment with effective systemic antibiotics, and replacement of a new shunt in a new site after evidence of CSF inflammation has subsided. Recent preliminary experience combining systemic antibiotics, local instillation of antibiotics into the shunt reservoir or tubing, and revision of the distal shunt appears to offer hope of an effective alternative therapy without total shunt removal. Comparison of this approach to the previous "gold standard" in a well-designed prospective study is a high priority. In addition, attempts to reduce bacterial colonization of shunts by development of new shunt materials and the evaluation of newer antibiotics such as the quinolones in the prophylaxis and/or therapy of shunt infections should be encouraged.

UI	MeSH Term	Description	Entries
D002557	Cerebrospinal Fluid Shunts	Tubes inserted to create communication between a cerebral ventricle and the internal jugular vein. Their emplacement permits draining of cerebrospinal fluid for relief of hydrocephalus or other condition leading to fluid accumulation in the ventricles.	Cerebrospinal Fluid Shunt,Shunt, Cerebrospinal Fluid,Shunts, Cerebrospinal Fluid
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D006849	Hydrocephalus	Excessive accumulation of cerebrospinal fluid within the cranium which may be associated with dilation of cerebral ventricles, INTRACRANIAL HYPERTENSION; HEADACHE; lethargy; URINARY INCONTINENCE; and ATAXIA.	Communicating Hydrocephalus,Congenital Hydrocephalus,Obstructive Hydrocephalus,Post-Traumatic Hydrocephalus,Aqueductal Stenosis,Cerebral Ventriculomegaly,Fetal Cerebral Ventriculomegaly,Hydrocephalus Ex-Vacuo,Hydrocephaly,Aqueductal Stenoses,Cerebral Ventriculomegalies,Cerebral Ventriculomegalies, Fetal,Cerebral Ventriculomegaly, Fetal,Fetal Cerebral Ventriculomegalies,Hydrocephalus Ex Vacuo,Hydrocephalus Ex-Vacuos,Hydrocephalus, Communicating,Hydrocephalus, Congenital,Hydrocephalus, Obstructive,Hydrocephalus, Post-Traumatic,Post Traumatic Hydrocephalus,Stenoses, Aqueductal,Stenosis, Aqueductal,Ventriculomegalies, Cerebral,Ventriculomegalies, Fetal Cerebral,Ventriculomegaly, Cerebral,Ventriculomegaly, Fetal Cerebral
D000900	Anti-Bacterial Agents	Substances that inhibit the growth or reproduction of BACTERIA.	Anti-Bacterial Agent,Anti-Bacterial Compound,Anti-Mycobacterial Agent,Antibacterial Agent,Antibiotics,Antimycobacterial Agent,Bacteriocidal Agent,Bacteriocide,Anti-Bacterial Compounds,Anti-Mycobacterial Agents,Antibacterial Agents,Antibiotic,Antimycobacterial Agents,Bacteriocidal Agents,Bacteriocides,Agent, Anti-Bacterial,Agent, Anti-Mycobacterial,Agent, Antibacterial,Agent, Antimycobacterial,Agent, Bacteriocidal,Agents, Anti-Bacterial,Agents, Anti-Mycobacterial,Agents, Antibacterial,Agents, Antimycobacterial,Agents, Bacteriocidal,Anti Bacterial Agent,Anti Bacterial Agents,Anti Bacterial Compound,Anti Bacterial Compounds,Anti Mycobacterial Agent,Anti Mycobacterial Agents,Compound, Anti-Bacterial,Compounds, Anti-Bacterial
D001424	Bacterial Infections	Infections by bacteria, general or unspecified.	Bacterial Disease,Bacterial Infection,Infection, Bacterial,Infections, Bacterial,Bacterial Diseases
D012307	Risk Factors	An aspect of personal behavior or lifestyle, environmental exposure, inborn or inherited characteristic, which, based on epidemiological evidence, is known to be associated with a health-related condition considered important to prevent.	Health Correlates,Risk Factor Scores,Risk Scores,Social Risk Factors,Population at Risk,Populations at Risk,Correlates, Health,Factor, Risk,Factor, Social Risk,Factors, Social Risk,Risk Factor,Risk Factor Score,Risk Factor, Social,Risk Factors, Social,Risk Score,Score, Risk,Score, Risk Factor,Social Risk Factor