Pathogenesis, Diagnosis, and Treatment of Central Nervous System Catheter Infections

Central nervous system catheters are used to treat hydrocephalus in children and are the most common neurosurgical procedure performed in the United States. Unfortunately, these catheters are frequently infected with biofilm-forming bacteria such as Staphylococcus epidermidis and other bacteria. Biofilm formation significantly affects the immune response to infection, clinical symptoms, and the treatment required for these infections. Currently, catheters must be removed in addition to providing treatment with antibiotics. This chapter reviews the pathogenesis of central nervous system catheter infection as well as current recommendations for diagnosis and treatment. Outstanding questions include the contribution of glia such as microglia and astrocytes to pathogenesis as well as the impact of inflammation on neurologic outcomes in infants and children. Further study is needed to design optimal treatment options to resolve and prevent these infections.