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Chapter 11 : Infections of Central Nervous System Shunts

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Abstract:

Cerebrospinal fluid (CSF) shunt infections may lead to ventriculitis, ventricular compartmentalization, and cortical mantle thinning, as well as meningitis, subdural empyema, and seizures. In addition, shunt infections have been shown to increase mental retardation and deterioration of mental capacity. The manifestations of central nervous system (CNS) shunt infections are variable. The most common presentation is a nonspecific one consisting of mild fever, nausea, vomiting, malaise, or signs of increased intracranial pressure (ICP) such as headache or altered consciousness. A unique complication of patients with ventriculovascular shunts is the development of shunt nephritis, a form of acute glomerulonephritis. In the majority of these cases the infecting organism has been , but other bacteria such as corynebacteria can cause this complication. The choice of antimicrobial therapy must be individualized, depending upon the clinical appearance of the patient, cerebrospinal fluid findings, and local patterns of antimicrobial susceptibility. A wide variety of choices is available for treatment of gram-negative shunt infections. A number of expanded-spectrum cephalosporins (e.g. cefotaxime, ceftriaxone, and ceftazidime) achieve therapeutic concentrations in the cerebrospinal fluid (CSF) and ventricular fluid after intravenous administration in patients with inflamed meninges. Some experts prefer to treat CNS shunt infections with both systemic and intraventricular antibiotics because of patient-to-patient variability in antibiotic concentrations achieved in ventricular fluid after intravenous therapy alone.

Citation: Yogev R, Bisno A. 2000. Infections of Central Nervous System Shunts, p 231-246. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch11
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Figures

Image of Figure 1
Figure 1

Commonly used CSF shunting system. The proximal portion ( ) is inserted into one of the cerebral ventricles. The reservoir( ) allows an easy access for CSF fluid sampling, and patency testing and the pressure-regulating valve ( )regulate the CSF flow. The distal catheter can be inserted into various body cavities (e.g., the peritoneal cavity in the VP shunt, the pleural cavity in the ventriculopleural shunt, or the vena cava in the VA shunt).

Citation: Yogev R, Bisno A. 2000. Infections of Central Nervous System Shunts, p 231-246. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch11
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Image of Figure 2
Figure 2

Peritoneal cyst in an 11-month-old hydrocephalic infant with a malfunction of a VP shunt. The X ray shows the distal tip of the shunt catheter coiled in the left lower quadrant of the abdomen. The sonogram (inset) demonstrates that the catheter is contained within an echo-free cystic mass. (Courtesy of Thomas F. Boulden, LeBonheur Children's Medical Center, Memphis, Tenn.)

Citation: Yogev R, Bisno A. 2000. Infections of Central Nervous System Shunts, p 231-246. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch11
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References

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Tables

Generic image for table
Table 1

Shunt infection cure rates with various therapeutic modalities

Citation: Yogev R, Bisno A. 2000. Infections of Central Nervous System Shunts, p 231-246. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch11
Generic image for table
Table 2

Duration of antibiotic therapy for patients with shunt infections

Citation: Yogev R, Bisno A. 2000. Infections of Central Nervous System Shunts, p 231-246. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch11

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