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Infections of cerebrospinal fluid shunts and other devices

Authors
Larry M Baddour, MD, FIDSA, FAHA
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. 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 in children: Management and prognosis" and "Normal pressure hydrocephalus".)

The management of bacterial meningitis in neonates, children, and adults is discussed in detail separately. (See "Bacterial meningitis in the neonate: Treatment and outcome" and "Bacterial meningitis in children older than one month: Treatment and prognosis" and "Initial therapy and prognosis of bacterial meningitis in adults" and "Treatment of bacterial meningitis caused by specific pathogens in adults".)

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 [VP] shunt), although, less commonly, they drain into the vascular space (ventriculoatrial [VA] shunt) or the pleural space (ventriculopleural shunt).

Externalized devices (ventriculostomy catheters, also called external ventricular drains [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.

                             

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Literature review current through: Jul 2017. | This topic last updated: Aug 15, 2017.
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