Microbiology and Epidemiology of Pediatric and Young Adult Ventriculoperitoneal Shunt Infections

There are limited data regarding the microbiology and epidemiology of pediatric ventriculoperitoneal (VP) shunt infections. We identified 30 pediatric and young adult VP shunt infections within the Military Health System from 2008 to 2019 by pairing a procedure code for VP shunt malfunction with a diagnosis code for VP shunt or central nervous system (CNS) infection. We confirmed infection with cerebrospinal fluid (CSF) or CNS culture or CSF pleocytosis for each patient. Half of patients were < 12 months old and 57% were male. The median initial CSF white blood cell count was 114 cells/µL. Staphylococci were identified most frequently (31.4% coagulase-negative staphylococci and 25.7% Staphylococcus aureus). Gram-negative pathogens comprised 22.9% of all isolates. Seventy-three percent of infections were adequately covered by vancomycin alone and 19% required a fourth-generation cephalosporin or carbapenem. Our study therefore supports national guideline-recommended empiric therapy with vancomycin and an anti-pseudomonal beta-lactam for children with VP shunt infection.