====== Ventriculoperitoneal shunt infection ======

{{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1HoKZG5k4YSJTqoSobf3dT7yV0iMv4EcfaMkW1dctrsw1l8EXq/?limit=15&utm_campaign=pubmed-2&fc=20240207024238}}

see also [[Shunt infection]].

[[Ventriculoperitoneal shunt]] [[infection]] is the most common [[ventriculoperitoneal shunt complication]], followed by [[abdominal pseudocyst]], [[abscess]], and infected fluid collection
((Chung JJ, Yu JS, Kim JH, Nam SJ, Kim MJ. Intraabdominal complications
secondary to ventriculoperitoneal shunts: CT findings and review of the
literature. AJR Am J Roentgenol. 2009 Nov;193(5):1311-7. doi:
10.2214/AJR.09.2463. Review. PubMed PMID: 19843747.
)).


===== Epidemiology =====

see [[Ventriculoperitoneal Shunt Infection Epidemiology]].

===== Types =====


see [[Methicillin resistant Staphylococcus aureus ventriculoperitoneal shunt infection]].
----
see [[Staphylococcus epidermidis ventriculoperitoneal shunt infection]]
----
see [[Cryptococcus neoformans ventriculoperitoneal shunt infection]].

===== Risk factors =====
[[Ventriculoperitoneal shunt infection risk factors]].

===== Treatment =====

[[Ventriculoperitoneal shunt infection treatment]]

===== Outcome =====
[[Infection]] of [[ventriculoperitoneal shunt]] causes major [[morbidity]] and [[mortality]] in patients with [[cerebrospinal fluid shunt]]s. 

The prognosis of CSF shunt infections caused by Gram-negative bacteria (GNB) has been thought to be particularly poor. 

Stamos et al. reviewed all GNB shunt infections treated at Children's Memorial Hospital from January 1986 to January 1990 (n = 23). Of these infections 20 (87%) occurred within 4 weeks after shunt revision (median, 10 days). The most frequent symptoms were fever, lethargy, and irritability; the illness was not severe in the majority of these patients. 

[[Escherichia coli]] was isolated from 12 of 23 patients (52%), [[Klebsiella pneumoniae]] from 5 (22%), and mixed GNB from 3 (13%) patients. Initial treatment always included immediate [[shunt removal]], externalized ventricular drainage, and intravenous antibiotics. Extraventricular drainage revision and/or intraventricular antibiotics were required in four patients whose CSF cultures were persistently positive for GNB. At admission, these patients had CSF glucose levels of < 10 mg/dl and CSF positive for GNB by Gram's stain. The overall cure rate was 100%, and no recurrence was observed; however, a subsequent infection with a different organism developed in four patients. Only 2 of 19 patients (11%) who were followed up suffered apparent CNS damage. One patient died of unrelated causes shortly after treatment. Our findings indicate that 1) patients with GNB CSF shunt infections often appear relatively well at presentation; 2) CSF positive for GNB by Gram's stain and very low CSF glucose levels predict continued positive CSF cultures, despite appropriate antibiotic therapy; and 3) GNB CSF shunt infections can be successfully treated by prompt shunt removal, extraventricular drainage, and intravenous antibiotics
((Stamos JK, Kaufman BA, Yogev R. Ventriculoperitoneal shunt infections with
gram-negative bacteria. Neurosurgery. 1993 Nov;33(5):858-62. PubMed PMID:
8264883.
)).



===== Costs =====
Higher public [[expenditure]]s were observed in the group of children undergoing [[ventriculoperitoneal shunt]] due to higher rates of [[ventriculoperitoneal shunt infection]]s and mechanical [[complication]]s requiring repeated [[hospitalization]]s and [[prosthesis]] [[replacement]]s. Public policies must be tailored to offer the best treatment to children with hydrocephalus and to make judicious use of public resources without compromising the quality of treatment
((Soriano LG, Melo JRT. Costs of pediatric hydrocephalus treatment for the Brazilian public health system in the Northeast of Brazil. Childs Nerv Syst. 2022 Aug 10. doi: 10.1007/s00381-022-05630-4. Epub ahead of print. PMID: 35948831.)).

===== Case series =====

[[Ventriculoperitoneal shunt infection case series]].

===== Case reports =====

[[Ventriculoperitoneal shunt infection case reports]].