Infections of CSF shunt and intracranial pressure monitoring devices.

Management of shunt infections varies, but externalization of shunt apparatus and the need for intraventricular antibiotics seem to have been rather uniformly adopted. No recent studies on EVD systems have been reported, largely because of the widespread use of alternatives such as the fiberoptic systems and the hollow subarachnoid bolt. Studies from the 1970s and personal experience with long-term monitoring in children with Reye's syndrome and head trauma indicate that it can be done safely with a low risk of infection. What the defining variable(s) for that low infection rate might be is not at all certain. Analysis of risk factors and the development of a study design that will provide statistically valid information must be accomplished before unbiased decisions can be made concerning the use of perioperative antibiotics in the management of CSF shunts. Until that is accomplished, the risks of such therapy must be carefully balanced against the possible (but unproven) benefit.