Patient and treatment characteristics by infecting organism in cerebrospinal fluid shunt infection

Tamara D. Simon, Matthew P. Kronman, Kathryn B. Whitlock, Samuel R. Browd, Richard Holubkov, John R.W. Kestle, Abhaya V. Kulkarni, Marcie Langley, David D. Limbrick, Thomas G. Luerssen, Jerry Oakes, Jay Riva-Cambrin, Curtis Rozzelle, Chevis N. Shannon, Mandeep Tamber, John C. Wellons, William E. Whitehead, Nicole Mayer-Hamblett

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1 Scopus citations

Abstract

Background. Previous studies of cerebrospinal fluid (CSF) shunt infection treatment have been limited in size and unable to compare patient and treatment characteristics by infecting organism. Our objective was to describe variation in patient and treatment characteristics for children with first CSF shunt infection, stratified by infecting organism subgroups outlined in the 2017 Infectious Disease Society of America’s (IDSA) guidelines. Methods. We studied a prospective cohort of children <18 years of age undergoing treatment for first CSF shunt infection at one of 7 Hydrocephalus Clinical Research Network hospitals from April 2008 to December 2012. Differences between infecting organism subgroups were described using univariate analyses and Fisher’s exact tests. Results. There were 145 children whose infections were diagnosed by CSF culture and addressed by IDSA guidelines, including 47withStaphylococcusaureus,52withcoagulase-negativeStaphylococcus,37withGram-negativebacilli,and9withPropionibacterium acnes. No differences in many patient and treatment characteristics were seen between infecting organism subgroups, including age at initial shunt, gender, race, insurance, indication for shunt, gastrostomy, tracheostomy, ultrasound, and/or endoscope use at all surgeries before infection, or numbers of revisions before infection. A larger proportion of infections were caused by Gram-negative bacilli when antibiotic-impregnated catheters were used at initial shunt placement (12 of 23, 52%) and/or subsequent revisions (11 of 23, 48%) compared with all other infections (9 of 68 [13%] and 13 of 68 [19%], respectively). No differences in reinfection were observed between infecting organism subgroups. Conclusions. The organism profile encountered at infection differs when antibiotic-impregnated catheters are used, with a higher proportion of Gram-negative bacilli. This warrants further investigation given increasing adoption of antibiotic-impregnated catheters.

Original languageEnglish
Pages (from-to)235-243
Number of pages9
JournalJournal of the Pediatric Infectious Diseases Society
Volume8
Issue number3
DOIs
StatePublished - Jan 1 2019

Keywords

  • Antibiotic
  • Antibiotic-impregnated catheter
  • Cerebrospinal
  • Infection
  • Shunt

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