Other etiologies with lower risk for infections include cerebral hemorrhage (11.9%), trauma (8.6%), post craniotomy (6.7%), and tumors/cysts (6.1%). The infection rate is higher with obstructive hydrocephalus (13.1%) compared to communicating hydrocephalus (6.5%) or idiopathic hydrocephalus (2.5%). The underlying conditions commonly associated with VP shunt infections include congenital hydrocephalus (24.8%) and spinal dysraphism (23.1%). ![]() There is some data to suggest that the odds of infection among male patients are 1.67 times higher than for female patients, however, the reasons for the difference are not clear. Furthermore, VP shunt insertion before one year of age is independently associated with a higher risk of VP shunt infections. The infection rate was much higher in pediatric patients (age < 17 years) compared with adult patients (21.3% vs. Gender and age are additional risk factors for VP shunt infections. A 20-year longitudinal study showed that the infection rate at six months was 5.6% and increased (cumulatively) to 6.4%, 8.0%, 9.0%, and 10.0% in one, 5, 10, and 20 years after shunt placement surgical procedure, respectively. Further risk factors for VP shunt infection include the expertise of the neurosurgeon, postoperative CSF leakage, and the use of a neuro-endoscope. Between 56% and 87% of infections occur within one month of shunt insertion. The possibility of ventriculoperitoneal (VP) shunt infection is most likely to be in the earlier days after shunt insertion. However, additional studies are required to determine if other Sub-Saharan countries have a higher incidence of Gram-negative bacterial VP shunt infections as compared to the United States. In this study, 39.6% of Kenyan children with VP shunt infections were infected with Gram-negative bacteria most of which were multidrug-resistant. published in 2015 showed that the incidence of Gram-negative bacteria causing VP shunt infections is probably higher outside the United States. Meanwhile, a retrospective study by Ochieng et al. Four of those infections were secondary to Gram-negative bacteria (1.2%). (2012) showed that 35 out of 333 (10.5%) shunts became infected. The incidence of CSF shunt infections widely varies from 1% to 30%, and up to 35% of the infected shunts had Gram-negative bacteria as a pathogen. For MEDLINE and Google Scholar, we searched titles and abstracts containing the words CSF and VP shunt and Gram-negative bacterial infections. For PubMed, we searched for the articles and titles with Gram-negative bacteria, Gram-negative bacterial infections, CSF, and VP shunts. We conducted a systematic search of the PubMed, MEDLINE, and Google Scholar databases from 1972 to 2020. ![]() The purpose of this review article is to discuss the epidemiology, clinical features, management, and prevention of Gram-negative ventriculoperitoneal (VP) shunts in adults. Initial empirical intravenous antimicrobial therapy is preferably broad spectrum with appropriate coverage for resistant Gram-negative pathogens and the duration of treatment depends upon pathogenesis, host factors, and clinical response to the therapy.Ĭonsidering the importance of this disease and associated clinical outcomes, in this review article, we have summarized the epidemiology, clinical features, management, and prevention of Gram-negative VP shunt infections in adults.Ĭerebrospinal fluid (CSF) infections and ventriculitis caused by Gram-negative bacteria have worse outcomes. Apart from cerebrospinal fluid (CSF) analysis, microbiological cultures and radiological studies are key diagnostic tools. The clinical presentation of a ventriculoperitoneal (VP) shunt infection includes the signs and symptoms of meningitis to fever with abdominal pain and peritonitis. There are multiple risk factors for CNS infection after shunt insertion, including younger age, obstructive hydrocephalus, shunt revision surgery, and trauma. The most common bacteria include Escherichia Coli, Citrobacter species, Enterobacter species, Serratia species, and Pseudomonas aeruginosa. Gram-negative bacterial infections of the central nervous system (CNS) have worse clinical outcomes.
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