Methicillin resistant Staphylococcus aureus ventriculoperitoneal shunt infection [Neurosurgery Wiki]

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=====Methicillin resistant Staphylococcus aureus ventriculoperitoneal shunt infection=====
Data suggest that use of [[vancomycin]] as prophylactic agent for cerebrospinal shunt placement reduces the rate of [[shunt infection]]s in the context of high prevalence of [[Methicillin resistant Staphylococcus aureus]].
((Tacconelli E, Cataldo MA, Albanese A, Tumbarello M, Arduini E, Spanu T, Fadda 
G, Anile C, Maira G, Federico G, Cauda R. Vancomycin versus cefazolin prophylaxis
for cerebrospinal shunt placement in a hospital with a high prevalence of
meticillin-resistant Staphylococcus aureus. J Hosp Infect. 2008 Aug;69(4):337-44.
doi: 10.1016/j.jhin.2008.04.032. Epub 2008 Jul 7. PubMed PMID: 18602187.
)).

====Case series====
===2012===
A retrospective cohort analysis of 333 consecutive [[ventriculoperitoneal shunt]] series was performed at [[Seoul]] National University Children's Hospital in [[Korea]] between January 2005 and February 2011. Overall, 35 shunts (10.5%) were infected, which represented an [[infection]] rate of 0.075 infection cases per shunt per year. VP shunt infection occurred at a median of 1 month (range, 6 days to 8 months) after insertion. An independent risk factor for shunt infection was undergoing an operation before the first year of life (relative risk 2.31; 95% confidence interval, 1.19-4.48). The most common causative microorganism was coagulase negative staphylococci in 16 (45.7%) followed by [[Staphylococcus aureus]] in 8 (22.9%). Methicillin resistance rate was 83.3% among coagulase-negative staphylococci and S. aureus. In this study, cerebrospinal fluid shunt infection rate was 10.5%. Infection was frequently caused by methicillin-resistant coagulase-negative staphylococci and S. aureus within two months after shunt surgery. [[Vancomycin]] may be considered as the preoperative prophylaxis for shunt surgery in a situation where methicillin resistance rate is very high
((Lee JK, Seok JY, Lee JH, Choi EH, Phi JH, Kim SK, Wang KC, Lee HJ. Incidence
and risk factors of ventriculoperitoneal shunt infections in children: a study of
333 consecutive shunts in 6 years. J Korean Med Sci. 2012 Dec;27(12):1563-8. doi:
10.3346/jkms.2012.27.12.1563. Epub 2012 Dec 7. PubMed PMID: 23255859; PubMed
Central PMCID: PMC3524439.
)).

===1991===
In a study of ventriculoperitoneal shunt infections conducted retrospectively between 1983 and 1987 and prospectively in 1988 39 infections from 372 shunt procedures (incidence 10.5%) were identified. The most common organism isolated was [[Staphylococcus aureus]] (18; 47%) followed by [[Staphylococcus epidermidis]] (10; 26%). Forty-two per cent of staphylococci were methicillin-resistant. Gram-negative infections were associated with myelomeningoceles and Gram-positive infections with other forms of hydrocephalus (P = 0.048). Lymphocyte predominance was found more frequently than polymorphonuclear predominance in cerebrospinal fluid
((Cotton MF, Hartzenberg B, Donald PR, Burger PJ. Ventriculoperitoneal shunt
infections in children. A 6-year study. S Afr Med J. 1991 Feb 2;79(3):139-42.
PubMed PMID: 1994483.
)).

====Case reports====
===2009===
A 6-year-old female presented with a large staphylococcal abdominal abscess manifesting as abdominal distension without significant clinical signs or blood and cerebrospinal fluid findings of infection. The patient had undergone repeated surgeries for [[craniopharyngioma]] at 2 years of age and had suffered central pontine and extrapontine myelinolysis during the clinical course, had severely impaired hypothalamic function, and was in a vegetative state on presentation. In addition, she had previously suffered epidural, subdural, and cerebral parenchymal abscesses, which had resolved completely. She underwent percutaneous irrigation drainage of pus and removal of the shunt coupled with intense antibiotic administration, which cured the abscess without recurrence. Culture revealed methicillin-resistant Staphylococcus aureus. 

Preexisting intracranial infection, which had extended down into the abdominal cavity through the peritoneal tube of the shunt, coupled with the patient's impaired immune function, had probably caused the abdominal abscess. Abdominal abscess is a potential complication of ventriculoperitoneal shunting, and timely diagnosis and treatment may achieve a good outcome
((Tsutsumi S, Okura H, Suga Y, Akiyama O, Abe Y, Yasumoto Y, Ito M. [Case with
large abdominal abscess associated with a ventriculoperitoneal shunt]. No Shinkei
Geka. 2009 Apr;37(4):363-7. Japanese. PubMed PMID: 19364027.
)).

===2005===
Phenotypic variants of Staphylococcus aureus may be misidentified by routine microbiological methods, and they may also respond poorly to antibacterial treatment. Using molecular methods, we identified small-colony variants of methicillin-resistant S. aureus (which were misidentified by 3 widely used automated identification systems as methicillin-susceptible coagulase-negative staphylococci) as the cause of recurrent ventriculoperitoneal shunt-related meningitis
((Spanu T, Romano L, D'Inzeo T, Masucci L, Albanese A, Papacci F, Marchese E,
Sanguinetti M, Fadda G. Recurrent ventriculoperitoneal shunt infection caused by 
small-colony variants of Staphylococcus aureus. Clin Infect Dis. 2005 Sep
1;41(5):e48-52. Epub 2005 Jul 20. PubMed PMID: 16080075.
)).