Reinfection rates after following treatment guidelines in CSF shunted children

Journal of Neurosurgery: Pediatrics

In a recently reported large longitudinal cohort study of children who were treated for cerebrospinal fluid (CSF) shunt infection, the goal was to determine whether reinfection rates in CSF-shunted children with healthcare-associated ventriculitis/meningitis is altered by following Infectious Disease Society of America (IDSA) guidelines.

2017 IDSA guidelines pertinent to CSF shunts include: guidance for choice of antibiotic therapy that is specific for each infection-causing organism (S. aureus, coagulase-negative Staphyloccoci, P. acnes, Gram-negative bacilli, and Pseudomonas); recommendation for complete removal of CSF shunt and replacement with an external ventricular drain; and guidance on duration of antibiotic therapy prior to re-implanting CSF shunts (therapy duration also specific to causal organism).

            Fourteen of 124 first-time shunt infections were treated according to 2004 IDSA guidelines. Similarly, 3 of 135 first-time shunt infections were treated as recommended by 2017 IDSA guidelines. There was no statistically significant difference in the reinfection rate for children treated on or off guidelines. The most common reason for not following IDSA guidelines is duration of antibiotic therapy. Considering the 2004 guidelines, 74 CSF shunt infections were treated for longer than recommended, while 20 were treated for shorter than recommended duration. No difference was observed for reinfection rate based on therapy duration.

            The study concludes that there is no evidence that shunt reinfection rate is altered by following IDSA guidelines or using longer duration of antibiotic therapy. Therefore, efforts can be made to reduce the duration of antibiotic therapy as recommended by IDSA guidelines without increasing CSF shunt reinfection risk.

Brandon G. Rocque, MD MS
Birmingham, AL