Cerebrospinal Fluid Shunt Infections: A Multicenter Pediatric Study

Alastair McAlpine, Joan L. Robinson, Michelle Barton, Archana Balamohan, H. Dele Davies, Gwenn Skar, Marie Astrid Lefebvre, Ahmed Almadani, Dolores Freire, Nicole Le Saux, Jennifer Bowes, Jocelyn A. Srigley, Patrick Passarelli, John Bradley, Sarah Khan, Rupeena Purewal, Isabelle Viel-Thériault, Adrianna Ranger, Michael T. Hawkes

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Infections complicate 5%-10% of cerebrospinal fluid (CSF) shunts. We aimed to describe the characteristics and contemporary pathogens of shunt infections in children in Canada and the United States. Methods: Descriptive case series at tertiary care hospitals in Canada (N = 8) and the United States (N = 3) of children up to 18 years of age with CSF shunt infections from July 1, 2013, through June 30, 2019. Results: There were 154 children (43% female, median age 2.7 years, 50% premature) with ≥1 CSF shunt infections. Median time between shunt placement and infection was 54 days (interquartile range, 24 days-2.3 years). Common pathogens were coagulase-negative staphylococci (N = 42; 28%), methicillin-susceptible Staphylococcus aureus (N = 24; 16%), methicillin-resistant S. aureus (N = 9; 5.9%), Pseudomonas aeruginosa (N = 9; 5.9%) and other Gram-negative bacilli (N = 14; 9.0%). Significant differences between pathogens were observed, including timing of infection (P = 0.023) and CSF leukocyte count (P = 0.0019); however, differences were not sufficient to reliably predict the causative organism based on the timing of infection or discriminate P. aeruginosa from other pathogens based on clinical features. Empiric antibiotic regimens, which included vancomycin (71%), cefotaxime or ceftriaxone (29%) and antipseudomonal beta-lactams (33%), were discordant with the pathogen isolated in five cases. There was variability between sites in the distribution of pathogens and choice of empiric antibiotics. Nine children died; 4 (44%) deaths were attributed to shunt infection. Conclusions: Staphylococci remain the most common cause of CSF shunt infections, although antibiotic resistant Gram-negative bacilli occur and cannot be reliably predicted based on clinical characteristics.

Original languageEnglish (US)
Pages (from-to)449-454
Number of pages6
JournalJournal of Bone and Joint Surgery - Series A
Volume41
Issue number6
DOIs
StatePublished - Jun 1 2022

Keywords

  • CSF shunt infections

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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