Bacterial Infections of the Nervous System

Bacterial infections of the nervous system manifest themselves in several ways, most of which are neurologic emergencies. This chapter reviews the classic syndromes of meningoencephalitis and focal infection (cerebritis or abscess) and the syndromes of neurosyphilis, tuberculosis, botulism, leprosy, Lyme disease, Whipple disease, rickettsiosis, diphtheria, and ventricular shunt infections.

Molecular Characterization of Microbiota in Cerebrospinal Fluid From Patients With CSF Shunt Infections Using Whole Genome Amplification Followed by Shotgun Sequencing

Understanding the etiology of cerebrospinal fluid (CSF) shunt infections and reinfections requires detailed characterization of associated microorganisms. Traditionally, identification of bacteria present in the CSF has relied on culture methods, but recent studies have used high throughput sequencing of 16S rRNA genes. Here we evaluated the method of shotgun DNA sequencing for its potential to provide additional genomic information. CSF samples were collected from 3 patients near the beginning and end of each of 2 infection episodes. Extracted total DNA was sequenced by: (1) whole genome amplification followed by shotgun sequencing (WGA) and (2) high-throughput sequencing of the 16S rRNA V4 region (16S). Taxonomic assignments of sequences from WGA and 16S were compared with one another and with conventional microbiological cultures. While classification of bacteria was consistent among the 3 approaches, WGA provided additional insights into sample microbiological composition, such as showing relative abundances of microbial versus human DNA, identifying samples of questionable quality, and detecting significant viral load in some samples. One sample yielded sufficient non-human reads to allow assembly of a high-quality Staphylococcus epidermidis genome, denoted CLIMB1, which we characterized in terms of its MLST profile, gene complement (including putative antimicrobial resistance genes), and similarity to other annotated S. epidermidis genomes. Our results demonstrate that WGA directly applied to CSF is a valuable tool for the identification and genomic characterization of dominant microorganisms in CSF shunt infections, which can facilitate molecular approaches for the development of better diagnostic and treatment methods.

The Effectiveness of Antibiotic-Coated Ventriculoperitoneal Shunts for Prevention of Shunt Infections in Patients with Myelomeningocele

<b><i>Purpose:</i></b> Hydrocephalus is a common comorbidity among the newborns, with myelomeningocele (MMC) and ventriculoperitoneal (VP) shunts being frequently used for the treatment of such patients. In this study, we aimed to compare the effectiveness of antibiotic-free and antibiotic-coated shunts to reduce the rate of shunt infection in patients with hydrocephalus and accompanying MMC. <b><i>Methods:</i></b> 116 patients with hydrocephalus and MMC who were treated with VP shunts were included in the study. Shunt infection rates among antibiotic-free and antibiotic-coated shunts were compared. <b><i>Results:</i></b> Of the 116 patients included in the study, 39 had antibiotic-coated shunts and 77 had antibiotic-free shunts. Shunt infection developed in 4 of the 39 cases treated with antibiotic-coated shunts and in 5 of the 77 cases treated with shunts without antibiotics. No significant statistical difference was found between antibiotic-coated and antibiotic-free VP shunts in terms of shunt infection (<i>p</i> = 0.450, <i>p</i> &#x3e; 0.05). <b><i>Conclusion:</i></b> In patients with MMC, using VP shunts containing antibiotics was found not to have a protective effect in preventing shunt infection. Whether the sac is intact or ruptured does not affect this result.

Shunt infection and malfunction in patients with myelomeningocele

OBJECTIVEMyelomeningocele (MMC) is frequently complicated by symptomatic hydrocephalus, necessitating early permanent CSF diversion and revision surgeries. Shunt infections are a common cause of shunt malfunction. This study aims to characterize long-term shunt-related outcomes of patients undergoing MMC closure.METHODSA total of 170 patients undergoing MMC closure between the years of 1995 and 2017 were identified from a retrospective review of a prospectively populated surgical database at the Children’s Hospital of Pittsburgh. Patients who underwent MMC closure and required ventriculoperitoneal (VP) shunt insertion met criteria and were included in the primary study analysis. Analysis with a Fisher exact test was performed for categorical variables, and Mann-Whitney U-tests were utilized for numerical data.RESULTSOf the 158 total patients undergoing MMC closure and meeting inclusion criteria, 137 (87%) required VP shunt insertion. These 137 patients demonstrated a shunt revision rate of 21.1% per person-year and a shunt infection rate of 2.1% per person-year over a mean follow-up of 10.8 years. Patients had a mean of 3.4 ± 0.6 shunt surgeries prior to their first infection. Patients undergoing immediate shunt removal, external ventricular drain placement, or shunt replacement after clearing the infection had lower rates of subsequent infections than patients who initially were managed with shunt externalization (p < 0.001). Placement of a shunt at the time of MMC closure was not found to be a risk factor for infection. Of patients with initial shunt placement after the implementation of the Hydrocephalus Clinical Research Network protocol in 2011, the authors’ institution has had a shunt infection rate of 4.2% per person-year and a revision rate of 35.7% per person-year.CONCLUSIONSThis study describes long-term outcomes of shunted MMC patients and factors associated with shunt infections. Most patients underwent multiple revisions prior to the first shunt infection. Shunt externalization may be ineffective at clearing the infection and should be avoided in favor of early shunt removal and external ventricular drainage, followed by shunt replacement once infection is demonstrated to have cleared.

Cutibacterium acnes: the Urgent Need To Identify Diagnosis Markers

ABSTRACT Cutibacterium acnes role is well described during acne but remains a mystery regarding its implication in bone and prosthesis or cerebrospinal fluid shunt infections. The main issue is that these low-grade symptom infections are difficult to diagnose and lead to irreversible and grave sequelae for patients. Consequently, there is an urgent need to find new biomarkers to accelerate the diagnosis of disease, an issue addressed by Beaver et al. thanks to a promising proteomic approach.

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

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.