Microbiology and treatment of cerebrospinal fluid shunt infections in children

Infections of cerebrospinal fluid (CSF) shunts remain a common surgical complication causing significant morbidity in children with hydrocephalus. As most of the literature regarding these infections includes only small cohorts from a single institution's experience, there remain large knowledge gaps and little support for the prevailing management strategies. Regarding the microbiology of shunt infections, little has changed in the past 10 years, other than the emergence of methicillin-resistant strains of coagulase-negative staphylococcus (CoNS) and Staphylococcus aureus, which remain the two predominant etiologic agents. Molecular diagnostics such as multiplex PCR have been used to identify the complex microflora of shunt infections and in the future could prove a useful adjunct for early diagnosis and targeting of antimicrobial therapy. Antibiotic-impregnated catheters for use in external ventricular drains and CSF shunts have been adopted into clinical practice and appear to reduce the risk of shunt infection by susceptible organisms.