Tamara D Simon1, Nicole Mayer-Hamblett2, Kathryn B Whitlock3, Marcie Langley4, John R W Kestle4, Jay Riva-Cambrin4, Margaret Rosenfeld2, Emily A Thorell5. 1. Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, and Center for Clinical and Translational Research, Seattle Children's Research Institute, Washington tamara.simon@seattlechildrens.org. 2. Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, and Center for Clinical and Translational Research, Seattle Children's Research Institute, Washington. 3. Center for Clinical and Translational Research, Seattle Children's Research Institute, Washington. 4. Division of Pediatric Neurosurgery, Department of Neurosurgery. 5. Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah, Salt Lake City.
Abstract
BACKGROUND: The relationship between first and subsequent cerebrospinal fluid (CSF) shunt infections is poorly understood. By understanding the factors associated with increased risk of reinfection, researchers may provide optimal treatment strategies at the time of first infection. The objective of this study was to describe and compare children with and without CSF shunt reinfection. METHODS: A retrospective cohort study was performed among 118 children who underwent initial CSF shunt placement and developed first CSF shunt infection. The primary outcome variable was CSF shunt reinfection. Patient risk factors and medical and surgical management of initial CSF shunt placement and first CSF shunt infection were compared between children with and without reinfection. RESULTS: Of 118 children with first infection, 31 (26%) developed a reinfection during the study period (overall median follow-up, 2096 days). Factors associated with reinfection in this cohort included ventriculoatrial or complex shunt at initial CSF shunt placement, complications after first CSF shunt infection, and intermittent negative CSF cultures. CONCLUSIONS: Few patient or treatment factors were associated with reinfection. Factors associated with difficult-to-treat first CSF shunt infection, including complications after first CSF shunt infection and intermittent negative CSF cultures, were associated with reinfection. Clinicians who treat patients with unusual CSF shunts or more difficult first infections should have a high index of suspicion for reinfection after treatment is completed.
BACKGROUND: The relationship between first and subsequent cerebrospinal fluid (CSF) shunt infections is poorly understood. By understanding the factors associated with increased risk of reinfection, researchers may provide optimal treatment strategies at the time of first infection. The objective of this study was to describe and compare children with and without CSF shunt reinfection. METHODS: A retrospective cohort study was performed among 118 children who underwent initial CSF shunt placement and developed first CSF shunt infection. The primary outcome variable was CSF shunt reinfection. Patient risk factors and medical and surgical management of initial CSF shunt placement and first CSF shunt infection were compared between children with and without reinfection. RESULTS: Of 118 children with first infection, 31 (26%) developed a reinfection during the study period (overall median follow-up, 2096 days). Factors associated with reinfection in this cohort included ventriculoatrial or complex shunt at initial CSF shunt placement, complications after first CSF shunt infection, and intermittent negative CSF cultures. CONCLUSIONS: Few patient or treatment factors were associated with reinfection. Factors associated with difficult-to-treat first CSF shunt infection, including complications after first CSF shunt infection and intermittent negative CSF cultures, were associated with reinfection. Clinicians who treat patients with unusual CSF shunts or more difficult first infections should have a high index of suspicion for reinfection after treatment is completed.
Authors: Tamara D Simon; Kathryn B Whitlock; Jay Riva-Cambrin; John R W Kestle; Margaret Rosenfeld; J Michael Dean; Richard Holubkov; Marcie Langley; Nicole Mayer Hamblett Journal: Pediatr Infect Dis J Date: 2012-06 Impact factor: 2.129
Authors: Matthew J McGirt; Aimee Zaas; Herbert E Fuchs; Timothy M George; Keith Kaye; Daniel J Sexton Journal: Clin Infect Dis Date: 2003-03-18 Impact factor: 9.079
Authors: Allan R Tunkel; Rodrigo Hasbun; Adarsh Bhimraj; Karin Byers; Sheldon L Kaplan; W Michael Scheld; Diederik van de Beek; Thomas P Bleck; Hugh J L Garton; Joseph R Zunt Journal: Clin Infect Dis Date: 2017-03-15 Impact factor: 9.079
Authors: Tamara D Simon; Matthew P Kronman; Kathryn B Whitlock; Nancy E Gove; Nicole Mayer-Hamblett; Samuel R Browd; D Douglas Cochrane; Richard Holubkov; Abhaya V Kulkarni; Marcie Langley; David D Limbrick; Thomas G Luerssen; W Jerry Oakes; Jay Riva-Cambrin; Curtis Rozzelle; Chevis Shannon; Mandeep Tamber; John C Wellons; William E Whitehead; John R W Kestle Journal: J Neurosurg Pediatr Date: 2018-02-02 Impact factor: 2.375
Authors: Tamara D Simon; Matthew P Kronman; Kathryn B Whitlock; Samuel R Browd; Richard Holubkov; John R W Kestle; Abhaya V Kulkarni; Marcie Langley; David D Limbrick; Thomas G Luerssen; Jerry Oakes; Jay Riva-Cambrin; Curtis Rozzelle; Chevis N Shannon; Mandeep Tamber; John C Wellons Iii; William E Whitehead; Nicole Mayer-Hamblett Journal: J Pediatric Infect Dis Soc Date: 2019-07-01 Impact factor: 3.164
Authors: Kathryn B Whitlock; Christopher E Pope; Paul Hodor; Lucas R Hoffman; David L Limbrick; Patrick J McDonald; Jason S Hauptman; Jeffrey G Ojemann; Tamara D Simon Journal: PLoS One Date: 2021-01-06 Impact factor: 3.240