Of these infections, 70% are diagnosed within 1 month after surgery and more than 90% within 6 months. However, vps infection is a common and serious complication with high rates of mortality and morbidity. A vp shunt is most at risk for an infection secondary to an abdominal infection. In the past, temporary subgaleal shunts were placed until the infant grew, then the temporary shunt was replaced with a permanent vp shunt. First, your child will need an operation to remove the infected shunt and put in a temporary drainage device. In the absence of clinical evidence of a csf shunt infection, routine cultures of shunt components, when shunts are removed for other indications, is not recommended. Typically this contamination will cause an internal shunt colonisation where the bacteria settle and grow on the internal wall of the shunt catheter and. Section of pediatric neurosurgery catholic university medical school, rome introduction the history of the treatment of hydrocephalus by using cerebrospinal fluid csf. Medications for shunt infection medication list about shunt infection.
Diagnosis and management of shunt complications in the treatment. As a result of this study, a new protocol for shunt procedures involving modifications in the immediate pre, intra, and postoperative management of children undergoing shunt implantation was initiated. Risk factors associated with the perioperative and operative period are of critical importance so that we can see reductions in the infection rate. On day 3, a ventriculoperitoneal vp shunt was inserted for hydrocephalus with gross ventriculomegaly. Pdf ventriculoperitoneal shunt infection and appendicitis. Shunt infection is a common complication of shunt surgery. In patients with infected ventriculoperitoneal shunts and abdominal symptoms. However, when primary shunt infection is the cause of. Hydrocephalus is a condition that makes fluid build up inside the brain. We identified cases of infection in ventriculoperitoneal shunts from january 2000 until april. Hydrocephalus was diagnosed in patients clinically by history, symptoms and signs. Original article infections of ventriculoperitoneal shunt.
Pdf ventriculoperitoneal shunt vps placement is one of the most commonly performed neurosurgical procedures and is necessary to treat. The objective of this study was to investigate intracranial infections complicating vps surgery in adults with hydrocephalus. Imaging useful to exclude mechanical shunt malfunction often coexists. Treatment of ventriculoperitoneal shunt infection and. However, the good news is that the overall standard of care for patients with hydrocephalus appears to have greatly improved over the last 10 years with the advent of better facilities for investigation, new approaches to treatment, and. The nursing goals for a client with hydrocephalus may include improving cerebral tissue perfusion, reducing anxiety, preventing injury, and the absence of complications. Shunt obstruction and infection continue to be common problems with vp shunts, resulting in recurrent hospital admissions for revisions and replacements, amounting to billions in medical costs per year. The signs of shunt infection may include fever, neck stiffness, light sensitivity also called photophobia, headaches, or signs of hydrocephalus shunt. Department of neurosurgery patient information ventricularperitoneal shunt this leaflet is for patients with hydrocephalus who are going to have a ventricularperitoneal shunt, vp shunt, inserted.
Pdf evidencebased interventions to reduce shunt infections. Management of ventriculoperitoneal shunt infections in. The pathogenesis of neurosurgical shunt related infection is complex with interactions between the pathogen, the device and the unique local immunological environment of the central nervous system cns. T2 an emerging cause of ventriculoperitoneal shunt infections. A rare complication of ventriculoperitoneal shunt in a. Diagnosis and surgical treatment of appendicitis in children with a. Since antibiotics alone offer limited efficacy in the management of vp shunt infection vpsi 4, 5, expert recommendations state that a combination of antibiotic and surgical treatment is required to achieve the best chance of definitive cure. Original article infections of ventriculoperitoneal shunt and. Nursing care of infants with a ventriculoperitoneal shunt.
Blood cultures are recommended in patients with susnosis weak, low. It tells you about the operation you are going to have and about its risks and benefits. Shunt infection was reduced in all studies absolute risk reduction 2. The patient we report had onset of symptoms 4 weeks after vp shunt placement, likely reflecting an underlying infection before vp shunt placement. The approach to management of shunt infections is discussed here. While typical surgical methods of handling vp shunt infections involve removal and reimplantation of the shunt, different types of operations have used with success in select patients.
Infection and mechanical failure are common complications of vp shunts fever and new shunts are big risk factors for shunt infection children with a shunt that has been present for six months, along with absence of fever, vomiting and headache, are unlikely to have a shunt complication as the cause of their presentation. Ventriculoperitoneal shunt radiology reference article. Frequently, such infections result from colonisation and subsequent biofilm formation on the surfaces of the shunts by staphylococcus epidermidis. Ventriculoperitoneal shunt infection is an undesirable outcome in neurosurgery and as such, preventative strategies are being explored as well as new treatment options. Among the shunt complications, shunt infection is one of the most frequent occur rence and serious complication of vp shunt. Six of 10 cases resulted from shunt placement in persons previously infected 6,8. Vp shunt infection with serratia marcescens, a gramnegative anaerobic rod, usually is related to underlying abdominal disease. Subdural hematoma formation may occur with overshunting in cases of low pressure hydrocephalus. A protocol for diagnosis and management of cerebrospinal shunt.
Shunt infection can lead to abscess formation or shunt occlusion. Ventriculoperitoneal shunt infection caused by staphylococcus. Fever and progressive consciousness disturbance were the most clinical features. Insertion of a vp shunt in a premature neonate was associated with a nearly 5fold increase in the risk of shunt infection p shunt infection p. Mechanical complications include obstruction, disconnection or migration of any components of a shunt system either at the ventricular or peritoneal end. Infection perioperative management of ventriculoperitoneal. Alarming trends vikas kumar 1, ankit s shah 1, daljit singh 1, poonam s loomba 2, hukum singh 1, anita jagetia 1. Ventriculoperitoneal vp shunts drain excess cerebrospi nal fluid csf from. Clinical case reports of infection caused by this organism include native valve endocarditis, peritonitis, vertebral osteomyelitis and catheter. Vp shunting is a surgical procedure that primarily treats a condition called. Diagnosis and management of shunt complications in the treatment of childhood hydrocephalus tamburrini g. Shunt failure in the absence of shunt infection is a common occurrence. Ventriculoperitoneal shunt infection caused by staphylococcus lugdunensis.
The distal portion of the shunt can be internalized or externalized. The shunt system consists of a proximal catheter that sits in the lateral ventricle, a oneway valve to prevent backflow of csf and a distal catheter that sits in the peritoneal cavity. Shunt infections and their treatment clinical gate. Department of neurosurgery patient information ventricular. Vp shunt surgery is a commonly performed operation in neurosurgery. Diversionary cerebrospinal fluid shunt implantation has a high complication rate, with 5% to 15% of such shunts becoming infected. Most reported in recent literature indicates that overall rate of vp shunt cefoperazone sodium and sulbactam sodium. In most cases, the vp shunt is unaffected and left in place after careful perioperative inspection, while the appendix is removed 1,6.
Infections of ventriculoperitoneal shunt and a simple effective. Candida albicans ventriculoperitoneal shunt infections. The risks factors of vp shunt infection in this study, we retrospectively 15 cases who occurred vp shunt infection of a total 282 vp shunt procedures, resulting in an infection rate of 5. Apr 01, 2003 identification of risk factors for shunt infection and predictors of infectious pathogens may improve current methods to prevent and treat shunt infections. Cns shunt infections is a topic covered in the johns hopkins abx guide to view the entire topic, please sign in or purchase a subscription official website of the johns hopkins antibiotic abx, hiv, diabetes, and psychiatry guides, powered by unbound medicine. Similarly, in infants, who appear to have higher shunt infection rates, the majority of infections occurred in the first 3 months after surgery. A proportion of patients with shunt infection will have a blocked shunt. A 30yearold man with history of neonatal hydrocephalus requiring ventriculoperitoneal shunt placement presented with mycobacterium abscessus shunt infection despite no shunt manipulation over 10 years prior to presentation. Mycobacterium abscessus ventriculoperitoneal shunt. However, ventriculoperitoneal shunt infection is a serious complication, commonly with an underlying. The only independent risk factor that predicted failure was retention of the vp shunt, regardless of the strategy. Pdf fungal infection of a ventriculoperitoneal shunt. Here are five 5 nursing care plans ncp for hydrocephalus. Tbi patients with both a vp shunt and a cns infection had a higher risk of developing newonset acute appendicitis hr 4.
Shunt tap only done by neurosurgeon unless critically high icp and no surgeon available lp often misses csf shunt infections and has no role when shunt infection is suspected. Cerebrospinal fluid csf shunts are used in the setting of hydrocephalus to divert csf to another part of the body for absorption. This study was carried out to evaluate the infection rate associated with cns shunts, assess the frequency of. To prevent infection associated with shunt placement, antibioticimpregnated shunt systems are increasingly being used. Internalized shunts most commonly drain into the peritoneum ventriculoperitoneal vp shunt, although, less commonly, they drain into the vascular space ventriculoatrial va shunt or the pleural space ventriculopleural shunt. Our primary purpose was to report the successful treatment of ventriculoperitoneal shunt infection and ventriculitis caused by a. The diagnostic usefulness of laboratory parameters in patients with ventriculoperitoneal shunt infection is as follow. Twelve percent of evaluations for csf in fection in the s 2 and s1 groups, respectively, were undertaken in patients with an external drain for reasons other than infection. Mar 01, 2008 to determine the rate and the type of ventriculoperitoneal vp shunt infections in infants and children admitted to king fahad hofuf hospital of alahsaa area at the eastern province of saudi arabia. Shunt infection remains the foremost problem of shunt implantation after mechanical malfunctions. These recommendations are based on case series, expert opinion. The clinical presentation was similar to that of other forms of shunt infection, yet the pathogenesis may be similar to that of h.
Shunt tap if concerned for infection this is usually done by or in consultation with neurosurgery a normal lumbar puncture does not rule out ventriculitis shunt infection imaging shunt series ap and lateral skull, ap chest and abdomen. Recovery of cryptococcus gattii from an infected ventriculo. Complications of vp shunt surgery may be broadly divided into 1 mechanical and 2 infective complications. Both cases were caused by strains that could not be typed. A ventriculoperitoneal vp shunt is a medical device that relieves pressure on the brain caused by fluid accumulation. This article describes treatment of two patients suffering from a vp shunt infection with s. On day 25, he developed fever with positive cerebrospinal fluid bacterial culture for enterobacter. Sep 22, 20 ventriculoperitoneal shunts are the most commonly used method of diverting csf flow for the treatment of hydrocephalus of any cause. Ventriculoperitoneal shunt tube infection and changing. If your child has a ventriculoperitoneal shunt vp shunt, you might have questions about it.
The majority of shunt infections occur within 3 months of the shunt surgery. A shunt infection happens when bacteria get in the area around the vp shunt. Ventriculoperitoneal vp shunts are a device used to shunt cerebrospinal fluid in the treatment of hydrocephalus as the name suggests, a catheter is placed with its tip in the ventricle. Shunt infections are usually caused by the patients own skin organisms most common is staphylococcus epidermidis, which gain access to shunt tubing during the shunt procedure. Often patients will present with symptoms of shunt malfunction as well as symptoms of infection, such as fever, however, this is not. Ventriculoperitoneal shunt infections and reinfections in. Nov 15, 2014 ventricular shunts are the most common neurosurgical procedure performed in the united states. As the name suggests, a catheter is placed with its tip in the ventricle. Although obstruction and infection are the most common causes of shunt malfunction, other complications can occur as well, including bowel. The second most common reason for being sued for negligence in neurosurgery is a problem related to hydrocephalus management the first being spinal surgery. Followup ranged from 2 to 10 years and was available for 23 of the. N2 staphylococcus lugdunensis, a coagulasenegative staphylococcus first described in 1988, has gained recognition as an organism with considerable pathogenic capability in adults.
A shunt infection is an infection of a shunt a hole or a small passage which allows movement of fluid from one part of the body to another. The value of creactive protein in the management of shunt. Ventriculoperitoneal shunt infections in infants and children. Pdf distribution of factors causing ventriculoperitoneal shunt. The rate of shunt infection is about 1015%, and 95% of infections will occur in the first 5 days after surgery. Incidence and risk factors of ventriculoperitoneal shunt. As a foreign object within the body, a shunt can cause infection. Read about keeping your child safe with a vp shunt.
The external portion of the catheter is connected to a v. Shunt infection causes shunt malfunction and is source of much morbidity for the patient. Overdrainage can cause the ventricles to collapse, tearing blood vessels and causing headache or further complications. If a csf shunt or drain is removed for indications other than infection, cultures of shunt or drain components are not recommended strong, moderate. We report an additional two cases of candida albicans ventriculoperitoneal shunt infection in immunocompetent preterm infants, and discuss the unique features and treatment of our cases in light of those reported previously. An unusual cause of ventriculoperitoneal shunt infection. A term infant with antenatally diagnosed complex central nervous system anomalies was delivered in good condition by elective caesarean section. Management of ventriculoperitoneal shunt infections in adults.
Tssr was the most effective strategy when vp shunt replacement was attempted. This condition occurs when excess cerebrospinal fluid csf collects in the brains ventricles. Infection associated with a ventriculoperitoneal shunt is a severe complication with a high morbidity and substantial mortality. Ventriculoperitoneal shunt tube infection and changing pattern of antibiotic sensitivity in neurosurgery practice. A ventriculoperitoneal vp shunt is a device used to relieve excessive pressure on the brain. Risk factors for pediatric ventriculoperitoneal shunt. Two 1% of 165 episodes of haemophilus influenzae infection of the central nervous system occurred in patients with cerebrospinal fluid shunts.
Signs and symptoms of early vp shunt infection in a tertiary hospital kaisar haroon 1, tania taher2, mokhlasur rahman 3, kanak kanti barua 4 abstract. This can let pressure build up in your childs brain. Infection remains the most significant complication of ventriculoperitoneal shunt vps surgery. Incidence and risk factors of ventriculoperitoneal shunt infections. Infection may develop when the shunt is colonized by skin flora. Ventriculoperitoneal shunt placement stephanie bartkowicz csulacsmc 2. When this happens, the shunt can stop working properly. The authors present a 4yearold male with history of intraventricular hemorrhage resulting in hydrocephalus who presented with an m.
Cure was not achieved until complete removal of all cns shunt foreign body was performed despite initial adequate. Vp shunting is a surgical procedure that primarily treats a condition called hydrocephalus. The cdc healthcareassociated infection hai prevalence survey found that there were an estimated 110,800 surgical site infections ssis associated with inpatient. Signs and symptoms of early vp shunt infection in a tertiary. Incidence of vp shunt infection of the 333 inserted shunts, 35 shunts 10. There were 4 independent risk factors for shunt infection. Haemophilus influenzae infections of cerebrospinal fluid. It also tells you what to do if you have any questions or. Your child will need to stay in hospital while we treat the shunt infection. Twelve percent died of related causes and 10% presented superinfection of the csf temporary drainageexternalized peritoneal catheter. Most surgeons use antibiotics of their choice whereas limited centres follow their own antibiotic policy. Pdf ventriculoperitoneal shunt infection caused by. Outcome analysis of ventriculoperitoneal shunt surgery in. Early diagnosis of ventriculoperitoneal shunt infections.
The patient baby girl 8 days old born 515 o born at 38 weeks no known allergies admitted to nicu after birth diagnosis. Patients who underwent vps surgery for hydrocephalus between 2000 and 2016 were included. Signs and symptoms of early vp shunt infection in a. The following steps are used to treat a shunt infection. The external portion of the catheter is connected to a valve that regulates the flow of csf based on a preset pressure. This hydrocephalus treatment is often complicated by infection of the device with biofilmforming bacteria. Vp shunt needs a skillful expert to prevent shunt infection and serious intra. Hence, early diagnosis and effective treatment is compulsory. In patients presenting with symptoms of shunt malfunction, infection should always be suspected since shunt infection is a serious complication with a great potential for severe morbidity and mortality 16,17.
Mycobacterium abscessus ventriculoperitoneal shunt infection. There are some serious situations in which the brain becomes in danger of physical compression due to pressure from fluid or blood. There are no guidelines to choose antibiotics in case of shunt infection. An infected shunt is treated with surgery and antibiotics. Ventriculoperitoneal introduction cerebrospinal fluid shunt devices are commonly indicated for the treatment of hydrocephalus in infants, and have served to improve survival and reduce mortality. Indications for shunt placement and other issues related to hydrocephalus are discussed separately. Ventriculoperitoneal shunt infections p sarguna, v lakshmi abstract central nervous system cns shunt infection is a cause of significant morbidity, causing shunt malfunction and chronic ill health. Diagnosis and management of shunt complications in the. Vp shunt infection is a major concern for the treating surgeon. Ventriculoperitoneal shuntrelated infections caused by. To analyze shunt infection rate and identify risk factors, a retrospective cohort analysis of 333 consecutive vp shunt series was performed at seoul national university childrens hospital in. Evidencebased interventions to reduce shunt infections. Ventriculoperitoneal vp shunts are a device used to shunt cerebrospinal fluid in the treatment of hydrocephalus.