How long should cerebrospinal fluid cultures be held to detect shunt infections?

2009 ◽  
Vol 4 (2) ◽  
pp. 184-189 ◽  
Author(s):  
Atman Desai ◽  
Stuart Scott Lollis ◽  
Symeon Missios ◽  
Tarek Radwan ◽  
Deborah E. Zuaro ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Pseudomonas Aeruginosa ◽  
Cerebrospinal Fluid ◽  
Antibiotic Treatment ◽  
Shunt Infection ◽  
Significant Difference ◽  
Few Data ◽  
Prior Antibiotic Treatment ◽  
Shunt Infections ◽  
Observation Period

Object Infections of CSF hardware may be indolent, and some patients have received antibiotic treatment for various reasons before CSF is obtained to check for a shunt infection. At present, there are few data in the literature to guide the decision as to how long to hold CSF specimens when attempting to diagnose hardware infections, and institutions vary in the duration at which cultures are considered “final.” Methods The authors reviewed the microbiology data from CSF specimens obtained from shunts, ventriculostomies, reservoirs, and lumbar drains at their institution over a 36-month period to discover how long after collection cultures became positive. The authors also sought to discover whether this time was affected by prior treatment with antibiotics. Results Of 158 positive CSF specimens obtained from hardware, the time to recovery ranged between 1–10 days, with a mean of 3.02 days (SD 2.37 days, 95% CI 2.66–3.38 days). One hundred and twenty-seven positive specimens were associated with clinical infections, and ~ 25% of these grew organisms after > 3 days, with some as long as 10 days after specimens were obtained. The most common organisms grown from individual patients were coagulase-negative Staphylococcus spp (34 cultures), Propionibacterium spp (21), Bacillus spp (6), Pseudomonas aeruginosa (4), and Staphylococcus aureus (4 cultures). Mean and maximum days to recovery were different across species, with S. aureus showing the shortest and Propionibacterium spp showing the longest incubation times. There appeared to be no significant difference in the time to recovery between specimens obtained in patients who had received prior antibiotic treatment versus those who had not. Conclusions A substantial number of positive CSF specimens obtained in patients with clinical infections grew bacteria after > 3 days, with some requiring as long as 10 days. Thus, a routine 10-day observation period for CSF specimens can be justified.

Detailed standardized protocol to prevent cerebrospinal fluid shunt infection

2020 ◽  
Vol 132 (3) ◽  
pp. 755-759
Author(s):  
Yuma Okamura ◽  
Keisuke Maruyama ◽  
Shin Fukuda ◽  
Hiroshi Horikawa ◽  
Nobuyoshi Sasaki ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Postoperative Infection ◽  
Shunt Infection ◽  
Csf Shunt ◽  
Patient Age ◽  
Protocol Implementation ◽  
Patient Âgé ◽  
Significant Difference ◽  
Before And After ◽  
Shunt Infections

OBJECTIVEWhile cerebrospinal fluid (CSF) shunt surgery plays an essential role in the treatment of hydrocephalus, postoperative infection due to the implantation of foreign materials is still one of the most common and potentially serious complications of this procedure. Because no previously reported protocol has been proven to prevent postoperative infection after CSF shunt surgeries in adults, the authors investigated the effectiveness of a protocol introduced in their institution.METHODSA detailed standardized surgical protocol to prevent infection in patients undergoing CSF shunt surgeries was introduced in the authors’ institution in December 2011. The protocol included a series of detailed rules regarding the surgical procedure, the surgical environment to minimize contamination from air, double gloving, local injection of antibiotics, and postoperative management. The rate of CSF shunt infection during the 3 years after surgery before and after implementation of the protocol was compared in patients undergoing their first CSF shunt surgeries. The inclusion periods were from January 2006 to November 2011 for the preprotocol group and from December 2011 to December 2014 for the postprotocol group.RESULTSThe study included 124 preprotocol patients and 52 postprotocol patients. The mean patient age was 59 years in both groups, ranging from 40 days to 88 years. Comparison of patient background factors, including known risk factors for surgical site infections, showed no significant difference between the patient groups before and after implementation of the protocol. While 9 patients (7.3%) developed shunt infections before protocol implementation, no shunt infections (0%) were observed in patients who underwent surgery after protocol implementation. The difference was statistically significant (p = 0.047).CONCLUSIONSThe authors’ detailed protocol for CSF shunt surgeries was effective in preventing postoperative infection regardless of patient age.

Conservative Management of Patients with Cerebrospinal Fluid Shunt Infections

Neurosurgery ◽  
2006 ◽  
Vol 58 (4) ◽  
pp. 657-665 ◽  
Author(s):  
Erwin M. Brown ◽  
Richard J. Edwards ◽  
Ian K. Pople
Keyword(s):  
Staphylococcus Aureus ◽  
Cerebrospinal Fluid ◽  
Success Rate ◽  
Conservative Management ◽  
Shunt Infection ◽  
Csf Shunt ◽  
Antibiotic Administration ◽  
Csf Shunt Infection ◽  
Shunt Infections

Abstract OBJECTIVE: In patients with cerebrospinal fluid (CSF) shunt infection, removal of the shunt and antibiotic administration is the current standard of care. In 1986, we developed a protocol for the conservative management of patients with infected but functioning shunts. Treatment was based on the administration of a combination of intraventricular and systemic antibiotics. Intraventricular antibiotics were instilled via a separate access device. The purpose of this report is to describe our experience with this therapeutic intervention. METHODS: An observational study of all patients treated for CSF shunt infection between 1986 and 2003 was undertaken. Cure was defined by sterile CSF after completion of therapy and sterile shunt components at next revision or long-term freedom from recurrent infection (follow-up period, 6–88 mo). RESULTS: In total, 43 of 122 patients with CSF shunt infections were treated conservatively according to our protocol. Overall, 84% of these patients were cured, with a 92% success rate for patients with infections caused by bacteria other than Staphylococcus aureus. This included 30 coagulase-negative staphylococcal infections, of which two were treatment failures. We abandoned conservative treatment of patients with Staphylococcus aureus infections after early experience demonstrated that the success rate (four treatment failures in seven patients) was markedly lower than that for other pathogens. During the treatment and follow-up periods, there were three deaths, two of which were unrelated to shunt infection; treatment failure could not be completely excluded in the remaining patient. There was no toxicity related to intraventricular antibiotic administration. The incidence of shunt blockage among patients who were treated conservatively was not significantly different from that among a large cohort of patients with uninfected shunts. Ten patients received part of their courses of treatment as outpatients. CONCLUSION: The success rate of conservative management of patients with CSF shunt infections caused by coagulase-negative staphylococci is comparable with those in the published literature for patients treated conventionally. This form of management avoids surgical intervention, with its attendant risks, and is safe.

scholarly journals Ventriculo-Peritoneal Shunt Infections in a Tertiary Center, 3 Years Experience

2021 ◽  
Author(s):  
Emre Dinçer ◽  
Nazan Dalgıç Karabulut
Keyword(s):  
Shunt Infection ◽  
Shunt Revision ◽  
Common Symptom ◽  
Skin Flora ◽  
Tertiary Center ◽  
Significant Difference ◽  
Common Etiology ◽  
Prolonged Hospital ◽  
Ventriculo Peritoneal Shunt ◽  
Shunt Infections

INTRODUCTION: Ventriculo-peritoneal shunt infection is the most important complication of shunt applications. In pediatric age, shunt infections are associated with shunt dysfunction, requirement for shunt revision, neurodevelopmental delay, prolonged hospital stay, and high treatment costs. In this study, we aimed to evaluate the characteristics of shunt infections of our patients and to compare the differences between early and late infections, infections caused by staphylococci and other strains and infection that did and did not recur. METHODS: In this retrospective study, shunt infections treated in the Pediatric Infection Clinic of Hamidiye Etfal Training and Research Hospital between July 2008 and July 2011 were evaluated. RESULTS: Forty-seven shunt infections in 42 patients were evaluated. Congenital anomalies were the most common etiology of hydrocephalus and fever was the most common symptom of the patients. Higher rates of early shunt infections, shunt infections in early childhood and infections caused by staphylococci species were observed. Patients with infections caused by staphylococci species received shorter duration of antibiotherapy (p=0.024). Infections that recurred in the six months of follow-up had higher rates of positive blood cultures (p=0.022). There was no statistically significant difference between early and late-term shunt infections. DISCUSSION AND CONCLUSION: Shunt infections were evaluated in different aspects in our study. Direct colonization of the shunt catheter still seems to be most important cause for the shunt infections because early infections and infections caused by skin flora were more common in our patient group.

Cerebral cyst infection with Micrococcus sedentarius

1980 ◽  
Vol 52 (1) ◽  
pp. 126-128 ◽  
Author(s):  
Gerald R. Greene ◽  
Catherine Mc Ninch ◽  
Eldon L. Foltz
Keyword(s):  
Cerebrospinal Fluid ◽  
Local Therapy ◽  
Shunt Infection ◽  
Congenital Hydrocephalus ◽  
Content Type ◽  
Cyst Infection ◽  
Focus Of Infection ◽  
Brain Cysts ◽  
Shunt Infections ◽  
Fine Print

✓ A 7-year-old boy with congenital hydrocephalus and a left septate cerebral cyst presented with a shunt infection due to Micrococcus sedentarius, resistant to all penicillins. The shunt infection was persistent despite several courses of parenteral, intraventricular, and intracyst antibiotics. Evaluation of the ventricular fluid revealed adequate “killing power” against the patient's microorganism. No extracranial focus of infection could be found. Computerized tomographic scanning, along with air ventriculography, identified a noncommunicating area of the cerebral cyst. Only when communication between this location and the rest of the cyst was established were the antibiotics efficacious. Undercirculated areas of cerebrospinal fluid should be sought when shunt infections and ventriculitis persist in spite of adequate parenteral and local therapy in patients with brain cysts.

Duration of In Vivo Antimicrobial Activity of Antibiotic-impregnated Cerebrospinal Fluid Catheters

Neurosurgery ◽  
2006 ◽  
Vol 58 (5) ◽  
pp. 930-935 ◽  
Author(s):  
Ananthababu Pattavilakom ◽  
Despina Kotasnas ◽  
Tony M. Korman ◽  
Chris Xenos ◽  
Andrew Danks
Keyword(s):  
Antimicrobial Activity ◽  
Cerebrospinal Fluid ◽  
Shunt Infection ◽  
In Vitro Models ◽  
Cerebrospinal Fluid Shunt ◽  
Antimicrobial Protection ◽  
Set Up ◽  
Shunt Infections

Abstract OBJECTIVE: Shunt infection is a major neurosurgical concern even after 50 years of experience with shunt surgery. Staphylococcus species are responsible for the majority of cerebrospinal fluid shunt infections. In vitro, antibiotic-impregnated cerebrospinal fluid shunt catheters (AIC) have demonstrated protection against multiple staphylococcus species and strains for reasonable periods. We aim to study the longevity of antimicrobial activity of AIC in vivo by using explanted catheters. METHODS: Twenty-five AICs (rifampicin [0.054%] and clindamycin [0.15%]) were explanted from 18 patients for noninfectious reasons, from 11 to 700 days postimplantation. The catheters were set up on standardized Staphylococcus aureus culture plates to detect antimicrobial activity. Unused fresh AIC segments were used as control in each culture plates. RESULTS: Fourteen explanted AICs demonstrated persistent antimicrobial activity against staphylococcal species. Antimicrobial activity was detected for a period of implantation up to 127 days. This is longer than that predicted by in vitro models. CONCLUSION: The persistent antimicrobial activity is likely to translate to ongoing in vivo antimicrobial protection. This period of protection exceeds that during which most shunt infections occur.

Cerebrospinal fluid ascites complicating ventriculoperitoneal shunting

1984 ◽  
Vol 61 (1) ◽  
pp. 180-183 ◽  
Author(s):  
Robert A. Yount ◽  
Mark C. Glazier ◽  
John Mealey ◽  
John E. Kalsbeck
Keyword(s):  
Cerebrospinal Fluid ◽  
Blood Cell ◽  
Surgical Intervention ◽  
Shunt Infection ◽  
Content Type ◽  
Protein Levels ◽  
Ventriculoperitoneal Shunting ◽  
Wbc Count ◽  
Shunt Infections ◽  
Fine Print

✓ Four cases of cerebrospinal fluid (CSF) ascites secondary to ventriculoperitoneal shunting are described. It is possible to differentiate CSF ascites from a CSF-filled pseudocyst by the characteristic bowel gas pattern on films of the abdomen and by the presence of shifting dullness. Two of the patients had active shunt infections, and had ascitic fluid with a protein level greater than 3 gm% and a white blood cell (WBC) count greater than 1000/cu mm. Both were treated successfully with antibiotics and removal of the shunt from the peritoneum. Two other patients had no evidence of infection, protein levels of less than 2 gm%, and WBC count less than 100 cu mm. These disorders resolved spontaneously. A review of 18 cases reported in the literature shows thatthe etiology of CSF ascites in the absence of shunt infection is multifactorial, and no features are consistently present in all cases. Ascites without infection may resolve spontaneously without surgical intervention.

Factors contributing to the medical costs of cerebrospinal fluid shunt infection treatment in pediatric patients with standard shunt components compared with those in patients with antibiotic-impregnated components

2007 ◽  
Vol 22 (4) ◽  
pp. 1-4 ◽  
Author(s):  
Daniel M. Sciubba ◽  
Li-Mei Lin ◽  
Graeme F. Woodworth ◽  
Matthew J. McGirt ◽  
Benjamin Carson ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Medical Costs ◽  
Shunt Infection ◽  
Csf Shunt ◽  
Shunt Insertion ◽  
Average Hospital ◽  
Infection Treatment ◽  
Shunt Infections

Object Antibiotic-impregnated shunt (AIS) systems may decrease the incidence of cerebrospinal fluid (CSF) shunt infections. However, there is a reluctance to use AIS components because of their increased cost. In the present study the authors evaluated factors contributing to the medical costs associated with the treatment of CSF shunt infections in a hydrocephalic pediatric population, those implanted with AIS systems compared with those implanted with standard shunt systems. Methods The authors retrospectively reviewed data obtained in all pediatric patients who had undergone CSF shunt insertion at their institution over a 3-year period. All patients were followed up for 12 months after surgery. The independent association between AIS catheter use and subsequent shunt infection was assessed by performing a multivariate proportional hazards regression analysis. Factors contributing to the medical costs associated with shunt infection were evaluated. Results Two hundred eleven pediatric patients underwent 353 shunting procedures. Two hundred eight shunts (59%) were placed with nonimpregnated catheters and 145 shunts (41%) were placed with AIS catheters. Twenty-five patients (12%) with non-AIS catheters experienced shunt infection, whereas only two patients (1.4%) with AIS catheters had a shunt infection within the 6-month follow-up period (p < 0.01). Among infected patients, infected patients with standard shunt components had a longer average hospital stay, more inpatient complications related to infection treatment, and more multiple organism infections and multiple antibiotic regimens, compared with those with AIS components. Conclusions Although individual AIS components are more expensive than standard ones, factors contributing to medical costs are fewer in pediatric patients with infected shunts when the components are antibiotic-impregnated rather than standard.

scholarly journals ANTIBACTERIAL ACTIVITY AND PHYTOCHEMICAL SCREENING OF MANGIFERA INDICA ETHANOL AND AQUEOUS LEAVES EXTRACT AGAINST PSEUDOMONAS AERUGINOSA AND STAPHYLOCOCCUS AUREUS

2021 ◽  
Vol 8 (12) ◽  
pp. 262-269
Author(s):  
M. A. Garga ◽  
U. M. Garasin ◽  
M. Abdullahi ◽  
B. A. Muhammed ◽  
A. Yakubu ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Pseudomonas Aeruginosa ◽  
Antibacterial Activity ◽  
Mangifera Indica ◽  
Diffusion Method ◽  
Phytochemical Screening ◽  
Gram Staining ◽  
Significant Difference ◽  
Zones Of Inhibition ◽  
And Staphylococcus Aureus

The aim of this research is to investigate the antibacterial activity and identify the phytochemical constituents of Mangifera indica leafs on Pseudomonas aeruginosa and Staphylococcus aureus using disc diffusion method. The sample was collected fresh from the premises of Bioresources Development Center (BIODEC), Katsina, Katsina State and was dried and pounded into powder. The powdered leaves were extracted using ethanol and aqueous solvents. Various concentrations ranging from 500mg to 62.5mg were prepared. Test isolates were obtained from the Microbiology laboratory, Umaru Musa Yar’adua University Katsina (UMYUK) and were further authenticated using Gram staining and biochemical test. The bacterial inoculums were standardized to McFarland scale 0.5. Zones of inhibition were read after 24 hours at 370C. The results of the antibacterial study revealed that the ethanolic leaves extracts at 500mg/ml had effect on P. aeruginosa and S. aureus with zones of inhibition of 12mm and 6mm respectively. The results of the phytochemical screening revealed the presence of flavonoids, tannins, saponins, alkaloids and phenols where only alkaloids was found to be absent in the aqueous extract. There is no significant difference between the solvents and various concentrations used base on t-test data analysis.

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