The treatment of cerebrospinal fluid shunt infections - Results from a practice survey of the American Society of Pediatric Neurosurgeons

It is our impression that the management strategy for infected cerebrospina l fluid (CSF) shunts varies significantly among pediatric neurosurgeons. Th e purpose of this paper is to present the results of a practice survey on t he treatment of shunt infections which was distributed to all active member s of the American Society of Pediatric Neurosurgeons (ASPN). Eighty-four of 129 ASPN members (65%) responded to the survey. Most ASPN members remove t he shunt and place an external ventricular drain (EVD) to treat Staphylococ cus epidermidis (59.5%), S. aureus (64.3%) and gram-negative rod infections (67.9%). The second most common method of treatment was externalization of the shunt (33.3, 29.8 and 25%, respectively). The duration of antibiotic t reatment was extremely variable. When the shunt was removed and an EVD inse rted, the duration of antibiotic treatment for S. epidermidis and S. aureus ranged from 5 to 21 total days (2-21 days of sterile cultures). For gram-n egative rod infections treated with shunt removal and an EVD, the total dur ation of antibiotic therapy ranged from 5 to 24 days (2-37 days of sterile cultures). The majority of ASPN members remove the infected CSF shunt and p lace an EVD for the management of shunt infections. Significant variation e xists in the duration of antibiotic therapy. Determining the most effective duration of antibiotic therapy in an effort to shorten hospitalization and minimize complications without sacrificing efficacy will require further s tudy. Copyright (C) 2001 S. Karger AG, Basel.