The management of cerebrospinal fluid shunt infections: a clinical experience.

Fifty patients with infected cerebrospinal fluid shunts were treated by one of three forms of treatment: a) Twenty-two patients had shunt removal, systemic antibiotic treatment, and either external ventricular drainage or intermittent ventricular taps for decompression and antibiotic administration. b) Seventeen patients had removal and immediate replacement of the shunt with intrashunt and systemic antibiotics. c) Eleven patients received intrashunt and systemic antibiotics without shunt removal. In the first group, antibiotics were given for a period of one week; in the second and third groups, intravenous antibiotics were administered for a minimum period of three weeks, and intraventricular antibiotics twice daily for two weeks. In all patients ventricular CSF was obtained and cultured 48 hours after cessation of antibiotic therapy, and cultures were repeated within four months after completion of therapy. Twenty-one of 22 patients in the first group as well as 11 of 13 of the second group, were successfully treated. In the third group only four of the 11 patients responded to treatment.