Hector E James1, John S Bradley. 1. Lucy Gooding Pediatric Neurosurgery Center, University of Florida HSC/Jacksonville and Wolfson Children's Hospital, Jacksonville, FL 32207, USA. lgpncjax@yahoo.com
Abstract
OBJECTIVE: This report is limited to patients with a single cerebrospinal fluid (CSF) shunt infected by a single organism, and compares two treatment protocols. METHODS: In the initial protocol (1975-1991), patients underwent removal of the shunt system and received intravenous and intraventricular antibiotics. Intraventricular antibiotics were administered twice daily to those with external ventricular drainage. When CSF was cultured 48 h off all antibiotics and found to be sterile at 24 h of incubation, a new shunt was inserted. Follow-up CSF cultures were obtained in all patients between 1-6 months following placement of the new shunt. RESULTS: There were 25 patients (ages 1 month to 16 years; mean +/- SD: 23 +/- 4.0 months). CSF obtained from the shunt yielded the following: Staphylococcus epidermidis (19), Staphylococcus aureus (2), Streptococcus species (2), Serratia marcescens (1), and Propionebacterium species (1). The duration of intravenous antibiotics was 7-12 days (mean +/- SD: 9.7 +/- 1.3 days), and intraventricular antibiotic therapy was 6.2 +/- 1.7 days. Total hospital stay was 15.2 +/- 2.3 days. The follow-up period was 7.7 +/- 3.6 years. Following the initial protocol in another 15 patients (1992-2004), the treatment regime was modified in that intraventricular antibiotics were administered once daily in patients with external ventricular drainage, and the CSF was cultured at 24 h off antibiotics, instead of 48 h. Results were similar to the initial protocol with respect to days of antibiotic therapy and hospital stay. CONCLUSION: Based on our retrospective nonrandomized series, we believe patients with a single shunt and noncompartmentalized hydrocephalus can be successfully treated without a prolonged antibiotic course and lengthy hospital stay.
OBJECTIVE: This report is limited to patients with a single cerebrospinal fluid (CSF) shunt infected by a single organism, and compares two treatment protocols. METHODS: In the initial protocol (1975-1991), patients underwent removal of the shunt system and received intravenous and intraventricular antibiotics. Intraventricular antibiotics were administered twice daily to those with external ventricular drainage. When CSF was cultured 48 h off all antibiotics and found to be sterile at 24 h of incubation, a new shunt was inserted. Follow-up CSF cultures were obtained in all patients between 1-6 months following placement of the new shunt. RESULTS: There were 25 patients (ages 1 month to 16 years; mean +/- SD: 23 +/- 4.0 months). CSF obtained from the shunt yielded the following: Staphylococcus epidermidis (19), Staphylococcus aureus (2), Streptococcus species (2), Serratia marcescens (1), and Propionebacterium species (1). The duration of intravenous antibiotics was 7-12 days (mean +/- SD: 9.7 +/- 1.3 days), and intraventricular antibiotic therapy was 6.2 +/- 1.7 days. Total hospital stay was 15.2 +/- 2.3 days. The follow-up period was 7.7 +/- 3.6 years. Following the initial protocol in another 15 patients (1992-2004), the treatment regime was modified in that intraventricular antibiotics were administered once daily in patients with external ventricular drainage, and the CSF was cultured at 24 h off antibiotics, instead of 48 h. Results were similar to the initial protocol with respect to days of antibiotic therapy and hospital stay. CONCLUSION: Based on our retrospective nonrandomized series, we believe patients with a single shunt and noncompartmentalized hydrocephalus can be successfully treated without a prolonged antibiotic course and lengthy hospital stay.
Authors: Richard J Drew; Theresa S Cole; Maggie K Lee; Stéphane Paulus; Conor L Mallucci; Andrew Riordan Journal: Childs Nerv Syst Date: 2013-12-10 Impact factor: 1.475