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Infections of central nervous system shunts and other devices

Authors
Larry M Baddour, MD, FIDSA
Patricia M Flynn, MD
Thomas Fekete, MD
Section Editors
Stephen B Calderwood, MD
Morven S Edwards, MD
Deputy Editor
Anna R Thorner, MD

INTRODUCTION

Cerebrospinal fluid (CSF) shunts are used in the setting of hydrocephalus to divert CSF to another part of the body for absorption [1]. The approach to management of shunt infections is discussed here. Indications for shunt placement and other issues related to hydrocephalus are discussed separately. (See "Hydrocephalus" and "Normal pressure hydrocephalus".)

SHUNT DEVICES

The proximal portion of the shunt catheter is most commonly placed in one of the cerebral ventricles but may also be placed in an intracranial cyst or the lumbar subarachnoid space. The distal portion of the shunt can be internalized or externalized. Internalized shunts most commonly drain into the peritoneum (ventriculoperitoneal, or VP, shunt), although, less commonly, they drain into the vascular space (ventriculoatrial, or VA, shunt).

Externalized devices (ventriculostomy catheters, also called external ventricular drains, or EVDs) are temporary devices typically placed in the setting of acute hydrocephalus for intracranial pressure monitoring and therapeutic diversion of cerebrospinal fluid. They may also be placed for interim management of hydrocephalus during antibiotic therapy for an infected internalized device that has been removed.

Other externalized central nervous system (CNS) devices such as Ommaya reservoirs (for administration of antimicrobial drugs or cancer chemotherapy) can also become infected. The proximal portion of these devices is typically placed in the intraventricular space but may also be placed in an abscess cavity or tumor. The distal portion of the device is a reservoir placed under the scalp (less commonly in the lumbar space) and accessed via a needle when needed.

INCIDENCE AND RISK FACTORS

The rate of internalized device infection ranges from 5 to 15 percent [2-12]. The highest infection rates have been observed during the initial month after placement, in patients requiring serial revisions, and in patients undergoing revision after treatment for an infected shunt [3,11].

                  

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Literature review current through: Nov 2016. | This topic last updated: Thu Jun 09 00:00:00 GMT+00:00 2016.
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