CSF shunt infections:
- The usual symptoms include fever with headache/ nausea/ lethargy, tenderness or erythema over the subcutaneous tunnel and symptoms of peritonitis/pleuritis in patients with ventriculoperitoneal/ ventriculopleural shunts.
- The initial investigation should be a tap of the shunt chamber and sending the CSF for cell count, protein, sugar and aerobic cultures. The lab should be asked to incubate the samples for 10 days to detect organisms such as Propionibacterium acnes.
- For confirmed shunt infections the shunt should be removed and a temporary external ventricular drain inserted. The shunt should be sent for cultures.
- Antimicrobial therapy depends on the causative organism. For culture negative shunt infections/ pending culture reports, a combination of ceftriaxone and vancomycin may be used. If the organism is highly drug resistant/ not responding to treatment, antibiotics should be administered through the external ventricular drain.
- The time of shunt re implantation depends on the causative organism and extent of infection. It can be done as soon as after 2 days of negative cultures in patients with CONS and normal CSF sugar, or 7 days of negative cultures in patients with CONS and abnormal CSF findings, 10 days of negative cultures in patients with infection with S. aureus/ gram negative bacilli. The total duration of antimicrobial therapy varies from 7-10 days for CONS to 10-14 days for S. aureus and gram negative bacilli.