Cerebrospinal fluid shunt infections. Report of 41 cases and a critical review of the literature.

All shunt procedures performed at our institution from July 1982 to December 1987 were analyzed for factors possibly related to shunt infection. There were 41 infections detected in 31 patients for an overall rate of 6.9%. Only intraventricular hemorrhage (IVH) as an etiology of the hydrocephalus and internalization of an external ventricular drain (EVD) were found to correlate with septic risk. An extensive review of all the English language literature concerning shunt infections over the last 15 years was undertaken. Little consensus could be found among the 35 publications in regard to factors predisposing to shunt sepsis. Even the issue of antibiotic prophylaxis remains clouded as all papers examined exhibited methodologic flaws.