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ORIGINAL ARTICLE
Year : 2019  |  Volume : 21  |  Issue : 1  |  Page : 29-33

Ten-year retrospective study on ventriculoperitoneal shunt infections from a university teaching hospital, South India


1 Department of Microbiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
2 Department of Neurosurgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
3 Department of Infection Control Department and Administration, Amrita Institute of Medical Sciences, Kochi, Kerala, India

Correspondence Address:
Dr. Sushma Krishna
St. Martha's Hospital, Nrupatunga Road, Bengaluru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jacm.jacm_8_19

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BACKGROUND: Ventriculoperitoneal shunt insertions are one of the important neurosurgical procedures done to enhance the neurological functions and improve the survival of patients with hydrocephalus. However, shunt infections are associated with an increased risk of morbidity and the mortality of 30%–40%. The study objective was to evaluate the clinical features, aetiology, resistance pattern and outcome of patients with cerebrospinal fluid (CSF) shunt infections over a 10-year period (2001–2010) amongst the microbiologically-proven cases. METHODOLOGY: Retrospective chart review was carried out to evaluate the age, sex and aetiology of hydrocephalus, biochemical parameters, clinical features and outcome of the culture-positive cases. RESULTS: Out of the 184 post-procedure and initial (<24 months) CSF samples received, 28 of them were culture positive with a growth of 36 isolates. The shunt infection rate (unadjusted) was found to be 15.21%. Seventeen were male and 11 were female. Thirteen were children below the age of 1 year, 3 between 7 and 30 years and 12 were above 50 years. Congenital hydrocephalus and Post-meningitis were the commonly noted presentations (n = 9, 32.1%) patients. Fever (64.3%) and vomiting (46.4%) were the most common clinical symptoms. CSF pleocytosis (n = 13), low glucose (n = 5) and elevated proteins (n = 18) were seen, respectively, of the 18 records available. A total of 19 patients recovered from the episode and five documented deaths were noted. Three of the isolates persisted over 10 days with repeat isolations. The most common causative microorganism was Coagulase Negative Staphylococcus (CONS) n = 13 (36.5%) (in vitro resistance to methicillin was 36.3% and to gentamicin was 45.4%). CONCLUSION: CONS continues to be a challenge to neurosurgeons in the treatment of shunt infections. Adequate prophylactic antibiotics based on the local susceptibility pattern should be administered besides strengthening the infection control protocols of the hospital. Surveillance of healthcare-associated infections may well extend to shunt infections at the locations where insertions are carried out.


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