Corynebacterium Group JK pathogen in cerebrospinal fluid shunt infection

1988 ◽  
Vol 68 (4) ◽  
pp. 648-650 ◽  
Author(s):  
Gershon Keren ◽  
Tal Geva ◽  
Bianca Bogokovsky ◽  
Ethan Rubinstein
Keyword(s):  
Cerebrospinal Fluid ◽  
Normal Skin ◽  
Shunt Infection ◽  
Csf Shunt ◽  
Significant Feature ◽  
Csf Shunts ◽  
Laboratory Findings ◽  
Content Type ◽  
Central Nervous System Dysfunction ◽  
Skin Flora

✓ The clinical and laboratory findings in two cases of aerobic Corynebacterium Group JK infection of cerebrospinal fluid (CSF) shunts are described. These organisms have occasionally been reported as a cause of serious infections in man but have not been reported as a cause of shunt infection. In both cases, CSF pleocytosis was limited to 20 or 60 cells with variable protein and sugar values. Fever was a constant finding, frequently accompanied by signs of central nervous system dysfunction. Corynebacterium Group JK organisms are common contaminants of the normal skin flora. When isolated from the blood and/or the CSF of a patient with a CSF shunt who has symptoms and signs compatible with infection, the organism should not be dismissed as a contaminant. A significant feature of this group is its resistance to almost all presently available antibiotics including penicillin, the cephalosporins, and the aminoglycosides. These organisms are, however, sensitive to vancomycin.

Role of endoscopic third ventriculostomy at infected cerebrospinal fluid shunt removal

2012 ◽  
Vol 9 (3) ◽  
pp. 320-326 ◽  
Author(s):  
Tomohisa Shimizu ◽  
Mark G. Luciano ◽  
Toru Fukuhara
Keyword(s):  
Risk Factors ◽  
Cerebrospinal Fluid ◽  
Endoscopic Third Ventriculostomy ◽  
Shunt Infection ◽  
Secondary Outcome ◽  
Csf Shunt ◽  
Third Ventriculostomy ◽  
Cerebrospinal Fluid Shunt ◽  
Csf Shunts ◽  
Shunt Removal

Object Cerebrospinal fluid shunt infection is distressing, especially in the pediatric population. Usually, infected CSF shunts are removed, and after temporary external CSF drainage, reinsertion of the CSF shunt is necessary. Unfortunately, it is not rare to encounter CSF reinfection after shunt renewal, and furthermore, the reinserted CSF shunt is at a considerable risk of malfunction. Endoscopic third ventriculostomy (ETV) is a potent option in managing CSF shunt infection, although ETV failure may occur more frequently when it is used to remove an infected shunt. The authors retrospectively evaluated CSF reinfection after using ETV during removal of infected CSF shunts; then the longevity of ETV and of successive reinserted ventriculoperitoneal shunts (VPSs) after ETV failure were also examined. Methods Children with shunted hydrocephalus were retrospectively reviewed, and data on their initial CSF shunt infections were extracted. Thirty-six children underwent VPS reinsertion (the VPS group), and 9 underwent ETV after removal of the infected CSF shunt (the ETV group). As the primary outcome, ETV efficacy against CSF reinfection within 6 months was analyzed by comparing the reinfection rates, and the risk factors for CSF reinfection were analyzed by logistic regression. The longevity of the reinserted shunt in the VPS group was calculated using the Kaplan-Meier method, which was compared with ETV longevity as the secondary outcome, and also with the longevity of reinserted VPSs in the ETV group after ETV failure as the tertiary outcome. Results Reinfection of CSF was seen in 27.8% of children in the VPS group. Among 9 children in the ETV group, only 1 (11.1%) had CSF reinfection. However, logistic regression analysis failed to show that performing ETV was a significant factor protecting against CSF reinfection: the significant risk factors were younger age at reinsertion of VPS or ETV (p = 0.037) and a history of shunt revisions (p = 0.011). The longevity of reinserted VPSs in the VPS group was calculated to be 658 ± 166.3 days (mean ± SE). Longevity of ETV was compared in the analysis of the secondary outcome, which was 929.2 ± 511.1 days, and there were no significant differences between these durations. Only 2 ETVs stayed patent, and a VPS was eventually implanted in the other 7 children. The longevity of this reinserted VPS in the ETV group, calculated based on these 7 children, was 2011.1 ± 540.7 days, which was confirmed to be longer than that in the VPS group (p = 0.031). Conclusions Although the protective effect of using ETV during removal of an infected CSF shunt on reinfection is marginal, the ETV longevity can be considered equivalent to that of reinserted VPSs. Even if ETV failure occurs, the reinserted VPS has significantly better longevity than a VPS reinserted without using ETV, and use of ETV during infected CSF shunt removal can be considered a potent alternative or at least an adjunct to VPS reinsertion.

scholarly journals Action of Linezolid or Vancomycin on Biofilms in Ventriculoperitoneal ShuntsIn Vitro

2012 ◽  
Vol 56 (6) ◽  
pp. 2842-2845 ◽  
Author(s):  
Roger Bayston ◽  
Gautham Ullas ◽  
Waheed Ashraf
Keyword(s):  
Staphylococcus Aureus ◽  
Staphylococcus Epidermidis ◽  
Shunt Infection ◽  
Csf Shunt ◽  
Csf Shunts ◽  
Content Type ◽  
Shunt Removal ◽  
Biofilm Development ◽  
Surgical Shunt

ABSTRACTCerebrospinal fluid (CSF) shunts used to treat hydrocephalus have an overall infection rate of about 10% of operations. The commonest causative bacteria areStaphylococcus epidermidis, followed byStaphylococcus aureusand enterococci. Major difficulties are encountered with nonsurgical treatment due to biofilm development in the shunt tubing and inability to achieve sufficiently high CSF drug levels by intravenous administration. Recently, three cases ofS. epidermidisCSF shunt infection have been treated by intravenous linezolid without surgical shunt removal, and we therefore investigated vancomycin and linezolid against biofilms of these bacteriain vitro. A continuous-perfusion model of shunt catheter biofilms was used to establish mature (1-week) biofilms ofStaphylococcus aureus,Staphylococcus epidermidis(both methicillin resistant [MRSA and MRSE]),Enterococcus faecalis, andEnterococcus faecium. They were then “treated” with either vancomycin or linezolid in concentrations achievable in CSF for 14 days. The biofilms were then monitored for 1 week for eradication and for regrowth. Enterococcal biofilms were not eradicated by either vancomycin or linezolid. Staphylococcal biofilms were eradicated by both antibiotics after 2 days and did not regrow. No resistance was seen. Linezolid at concentrations achievable by intravenous or oral administration was able to eradicate biofilms of bothS. epidermidis(MRSE) andS. aureus(MRSA). Neither vancomycin at concentrations achievable by intrathecal administration nor linezolid was able to eradicate enterococcal biofilms. It is hoped that thesein vitroresults will stimulate further clinical trials with linezolid, avoiding surgical shunt removal.

Results of surgical treatment of neurocysticercosis in 69 cases

1986 ◽  
Vol 65 (3) ◽  
pp. 309-315 ◽  
Author(s):  
Benedicto Oscar Colli ◽  
Nelson Martelli ◽  
João Alberto Assirati ◽  
Hélio Rubens Machado ◽  
Sylvio de Vergueiro Forjaz
Keyword(s):  
Posterior Fossa ◽  
Complement Fixation Test ◽  
Shunt Infection ◽  
Shunt Revision ◽  
Csf Shunt ◽  
Increased Intracranial Pressure ◽  
Csf Shunts ◽  
Content Type ◽  
Cerebral Parenchyma

✓ The clinical course of 69 patients with neurocysticercosis who underwent surgery to control increased intracranial pressure (ICP) or cyst removal is analyzed. Increased ICP was caused by hydrocephalus in 63 patients, by cerebral edema in four, and by giant cysts in two. Skull x-ray films showed calcifications in 14% and signs of elevated ICP in 46%. Examination of cerebrospinal fluid (CSF) revealed pleocytosis with eosinophils in 52% of cases and a positive complement fixation test for cysticercosis in 66%. Ventriculography allowed localization of the CSF obstruction and ventricular cysts, and generally differentiated between an obstruction due to cysts and an inflammatory process. Computerized tomography showed cysts in the cerebral parenchyma and ventricular dilatation. Ventricular cysts were best seen when intraventricular metrizamide was used. Intracranial shunting and posterior fossa exploration were less effective in the treatment of hydrocephalus than was ventriculoatrial (VA) or ventriculoperitoneal (VP) shunting, although VA or VP shunting was associated with a high percentage of complications. Quality of survival was good in 87% of the cases in the first 3 postoperative months and in 93% of patients who survived 2 years after surgery. Fortyseven patients (68%) were readmitted one or more times for CSF shunt revision; 14 of them for shunt infection (meningitis). The early operative mortality rate was 1.8% for patients with VA or VP shunt placement and 5.3% for those with posterior fossa exploration. The authors conclude that placement of CSF shunts is indicated in the treatment of hydrocephalus, and cyst removal is indicated only when the cyst exhibits tumor-like behavior. Surgical exploration is also indicated when the diagnosis is uncertain.

Cerebrospinal fluid shunt infections with anaerobic diphtheroids (Propionibacterium species)

1976 ◽  
Vol 44 (5) ◽  
pp. 580-584 ◽  
Author(s):  
E. Dale Everett ◽  
Theodore C. Eickhoff ◽  
Richard H. Simon
Keyword(s):  
Cerebrospinal Fluid ◽  
Spinal Fluid ◽  
Cerebrospinal Fluid Shunts ◽  
Cerebrospinal Fluid Shunt ◽  
Laboratory Findings ◽  
Content Type ◽  
Central Nervous System Dysfunction ◽  
Symptoms And Signs ◽  
Shunt Infections ◽  
Fine Print

✓ The clinical and laboratory findings in six cases of anaerobic diphtheroid infection of cerebrospinal fluid shunts are described. These organisms have been infrequently reported as a cause of shunt infections but our data indicate that such infections may be more common than currently appreciated. Propionibacterium species are common contaminants of cerebrospinal fluid specimens, but when isolated from the spinal fluid of a patient with a shunt who has symptoms and signs compatible with infection, the organism should not be dismissed as a contaminant. Fever was a constant finding frequently accompanied by signs of central nervous system dysfunction. Spinal fluid pleocytosis was usually limited to 1 to 200 cells and protein and sugar values were variable. The organisms grow slowly, therefore spinal fluid cultures should be held for at least 14 days before they are reported as negative.

Presence of vitronectin and activated complement factor C9 on ventriculoperitoneal shunts and temporary ventricular drainage catheters

1999 ◽  
Vol 90 (1) ◽  
pp. 101-108 ◽  
Author(s):  
Fredrik Lundberg ◽  
Dai-Qing Li ◽  
Dan Falkenback ◽  
Tor Lea ◽  
Peter Siesjö ◽  
...  
Keyword(s):  
Shunt Infection ◽  
Csf Shunt ◽  
Complement Factor ◽  
Ventricular Drainage ◽  
Csf Shunts ◽  
Native Form ◽  
Content Type ◽  
Csf Shunt Infection ◽  
Catheter Surface ◽  
Fine Print

Object. The pathogenesis of cerebrospinal fluid (CSF) shunt infection is characterized by staphylococcal adhesion to the polymeric surface of the shunt catheter. Proteins from the CSF—fibronectin, vitronectin, and fibrinogen—are adsorbed to the surface of the catheter immediately after insertion. These proteins can interfere with the biological systems of the host and mediate staphylococcal adhesion to the surface of the catheter. In the present study, the presence of fibronectin, vitronectin, and fibrinogen on CSF shunts and temporary ventricular drainage catheters is shown. The presence of fragments of fibrinogen is also examined.Methods. The authors used the following methods: binding radiolabeled antibodies to the catheter surface, immunoblotting of catheter eluates, and scanning force microscopy of immunogold bound to the catheter surface. The immunoblot showed that vitronectin was adsorbed in its native form and that fibronectin was degraded into small fragments. Furthermore, the study demonstrated that the level of vitronectin in CSF increased in patients with an impaired CSF—blood barrier. To study complement activation, an antibody that recognizes the neoepitope of activated complement factor C9 was used. The presence of activated complement factor C9 was shown on both temporary catheters and shunts.Conclusions. Activation of complement close to the surface of an inserted catheter could contribute to the pathogenesis of CSF shunt infection.

scholarly journals Identification of Potential Cerebrospinal Fluid Biomarkers To Discriminate between Infection and Sterile Inflammation in a Rat Model of Staphylococcus epidermidis Catheter Infection

2019 ◽  
Vol 87 (9) ◽  
Author(s):  
Gwenn L. Skar ◽  
Matthew Beaver ◽  
Amy Aldrich ◽  
Dragana Lagundzin ◽  
Ishwor Thapa ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Rat Model ◽  
Staphylococcus Epidermidis ◽  
Interleukin 10 ◽  
Shunt Infection ◽  
Sterile Inflammation ◽  
Mass Spectrometry Analysis ◽  
Csf Shunt ◽  
Csf Biomarkers ◽  
Content Type

ABSTRACT Staphylococcus epidermidis cerebrospinal fluid (CSF) shunt infection is a common complication of hydrocephalus treatment, creating grave neurological consequences for patients, especially when diagnosis is delayed. The current method of diagnosis relies on microbiological culture; however, awaiting culture results may cause treatment delays, or culture may fail to identify infection altogether, so newer methods are needed. To investigate potential CSF biomarkers of S. epidermidis shunt infection, we developed a rat model allowing for serial CSF sampling. We found elevated levels of interleukin-10 (IL-10), IL-1β, chemokine ligand 2 (CCL2), and CCL3 in the CSF of animals implanted with S. epidermidis-infected catheters compared to sterile controls at day 1 postinfection. Along with increased chemokine and cytokine expression early in infection, neutrophil influx was significantly increased in the CSF of animals with infected catheters, suggesting that coupling leukocyte counts with inflammatory mediators may differentiate infection from sterile inflammation. Mass spectrometry analysis revealed that the CSF proteome in sterile animals was similar to that in infected animals at day 1; however, by day 5 postinfection, there was an increase in the number of differently expressed proteins in the CSF of infected compared to sterile groups. The expansion of the proteome at day 5 postinfection was interesting, as bacterial burdens began to decline by this point, yet the CSF proteome data indicated that the host response remained active, especially with regard to the complement cascade. Collectively, these results provide potential biomarkers to distinguish S. epidermidis infection from sterile postoperative inflammation.

Cerebrospinal fluid shunt infection: a prospective study of risk factors

2001 ◽  
Vol 94 (2) ◽  
pp. 195-201 ◽  
Author(s):  
Abhaya V. Kulkarni ◽  
James M. Drake ◽  
Maria Lamberti-Pasculli
Keyword(s):  
Risk Factors ◽  
Cerebrospinal Fluid ◽  
Shunt Infection ◽  
Csf Leak ◽  
Csf Shunt ◽  
Shunt System ◽  
Content Type ◽  
Increased Risk ◽  
Csf Shunt Infection ◽  
Fine Print

Object. Hydrocephalus is a common condition of childhood that usually requires insertion of a cerebrospinal fluid (CSF) shunt. Infection is one of the most devastating complications that may arise from the presence of CSF shunts. In this study, the authors prospectively analyzed perioperative risk factors for CSF shunt infection in a cohort of children. Methods. Between 1996 and 1999, 299 eligible patients underwent CSF shunt operations (insertions and revisions) that were observed by a research nurse at a tertiary care pediatric hospital. Several perioperative variables were recorded. All cases were followed postoperatively for 6 months to note any development of CSF shunt infection. A Cox proportional hazards model was used to analyze the relationship between the variables and the development of shunt infection. Thirty-one patients (10.4%) experienced shunt infection. Three perioperative variables were significantly associated with an increased risk of shunt infection: 1) the presence of a postoperative CSF leak (hazard ratio [HR] 19.16, 95% confidence interval [CI] 6.96–52.91); 2) patient prematurity (< 40 weeks' gestation at the time of shunt surgery: HR 4.72, 95% CI 1.71–13.06); and 3) the number of times the shunt system was inadvertently exposed to breached surgical gloves (HR 1.07, 95% CI 1.02–1.12). Conclusions. Three variables associated with an increased incidence of shunt infection have been identified. Changes in clinical practice should address these variables, as follows. 1) Great care should be taken intraoperatively to avoid a postoperative CSF leak. 2) Alternatives to placement of a CSF shunt in premature infants should be studied. 3) Surgeons should minimize manual contact with the shunt system and consider the use of double gloves.

Cerebrospinal fluid shunt infection

1984 ◽  
Vol 60 (5) ◽  
pp. 1014-1021 ◽  
Author(s):  
Beverly C. Walters ◽  
Harold J. Hoffman ◽  
E. Bruce Hendrick ◽  
Robin P. Humphreys
Keyword(s):  
Cerebrospinal Fluid ◽  
Initial Treatment ◽  
Clinical Presentation ◽  
Shunt Infection ◽  
Shunt Malfunction ◽  
Shunt Revision ◽  
Csf Shunts ◽  
Content Type ◽  
Operative Removal ◽  
Fine Print

✓ A retrospective study of the management of patients with infected cerebrospinal fluid (CSF) shunts was undertaken, covering the 20 years from 1960 to 1979, inclusive, and involving 222 patients with 267 infections. The data were analyzed with emphasis on influences surrounding treatment choice and subsequent outcome. Treatment was classified into three major categories: medical management (antibiotics alone), surgical management (antibiotics plus operative removal of the infected shunt), and no treatment (ranging from admission and observation only to shunt revision), the diagnosis of shunt infection having been missed. Results showed surgical treatment to be more efficacious than medical or no treatment, with a higher rate of initial cure, and lower morbidity and mortality rates. Also examined were the relationships among clinical presentation, infection rate, and results of specimens sent for culture, and initial treatment. The definitive nature of initial treatment was revealed to be directly proportional to the aggressiveness of microbiological investigation. This latter aspect was related to clinical presentation, with shunt malfunction being the least recognized symptom of shunt infection. Patients presenting with blocked shunts were less likely to receive therapy appropriate for infection than any other group, leading to the conclusion that shunt malfunction may be more specific to infection than heretofore believed.

scholarly journals Patient and Treatment Characteristics by Infecting Organism in Cerebrospinal Fluid Shunt Infection

2018 ◽  
Vol 8 (3) ◽  
pp. 235-243 ◽  
Author(s):  
Tamara D Simon ◽  
Matthew P Kronman ◽  
Kathryn B Whitlock ◽  
Samuel R Browd ◽  
Richard Holubkov ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Shunt Infection ◽  
Research Network ◽  
Csf Shunt ◽  
Coagulase Negative Staphylococcus ◽  
Gram Negative ◽  
Treatment Characteristics ◽  
Infection Treatment ◽  
Csf Shunt Infection ◽  
Univariate Analyses

Abstract Background Previous studies of cerebrospinal fluid (CSF) shunt infection treatment have been limited in size and unable to compare patient and treatment characteristics by infecting organism. Our objective was to describe variation in patient and treatment characteristics for children with first CSF shunt infection, stratified by infecting organism subgroups outlined in the 2017 Infectious Disease Society of America’s (IDSA) guidelines. Methods We studied a prospective cohort of children <18 years of age undergoing treatment for first CSF shunt infection at one of 7 Hydrocephalus Clinical Research Network hospitals from April 2008 to December 2012. Differences between infecting organism subgroups were described using univariate analyses and Fisher’s exact tests. Results There were 145 children whose infections were diagnosed by CSF culture and addressed by IDSA guidelines, including 47 with Staphylococcus aureus, 52 with coagulase-negative Staphylococcus, 37 with Gram-negative bacilli, and 9 with Propionibacterium acnes. No differences in many patient and treatment characteristics were seen between infecting organism subgroups, including age at initial shunt, gender, race, insurance, indication for shunt, gastrostomy, tracheostomy, ultrasound, and/or endoscope use at all surgeries before infection, or numbers of revisions before infection. A larger proportion of infections were caused by Gram-negative bacilli when antibiotic-impregnated catheters were used at initial shunt placement (12 of 23, 52%) and/or subsequent revisions (11 of 23, 48%) compared with all other infections (9 of 68 [13%] and 13 of 68 [19%], respectively). No differences in reinfection were observed between infecting organism subgroups. Conclusions The organism profile encountered at infection differs when antibiotic-impregnated catheters are used, with a higher proportion of Gram-negative bacilli. This warrants further investigation given increasing adoption of antibiotic-impregnated catheters.

Operative Related Infection Rates for Ventriculoperitoneal Shunt Procedures in a Children's Hospital

1987 ◽  
Vol 8 (2) ◽  
pp. 67-70 ◽  
Author(s):  
Janara J. Younger ◽  
James C.H. Simmons ◽  
Fred F. Barrett
Keyword(s):  
Cerebrospinal Fluid ◽  
Ventriculoperitoneal Shunt ◽  
Shunt Infection ◽  
Infection Risk ◽  
Csf Shunt ◽  
Infection Rates ◽  
Surgical Infection ◽  
Shunt Procedure ◽  
Csf Shunt Infection

AbstractWe determined the operative related cerebrospinal fluid (CSF) shunt infection rates for our institution over a 3-year period (1982 to 1984) using strictly defined numerator and denominator data. The minimum post-operative follow-up period was 12 months. The average surgical infection risk for a CSF shunt procedure at our institution during the study period was 13.3%. Annual infection rates were relatively constant (13.8%, 13.2% and 12.9%), however both quarterly (5.7% to 23.3%) and surgeon-specific (5.7% to 22.8%) rates varied widely. Infection rates calculated by using “traditional” numerator and denominator data were considerably lower (6.5% to 9.2%).Operative related CSF shunt infection rates should be determined by utilizing strictly defined numerator and denominator values in order to allow valid comparisons of published rates.

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