Ventriculoperitoneal shunt infection: Difference between revisions
No edit summary |
No edit summary |
||
| Line 31: | Line 31: | ||
==Management== | ==Management== | ||
*Emergent neurosurgical consultation and admission | |||
*Shunt tap | |||
**[[LP]] often misses CSF shunt infections and has no role when shunt infection is suspected | |||
*Imaging | |||
**Useful to exclude mechanical shunt malfunction (often coexists w/ infection) | |||
*[[Antibiotics]] | |||
**[[Cefepime]]/[[Ceftazidime]] or [[carbapenem]] + [[vancomycin]] | |||
==Disposition== | ==Disposition== | ||
| Line 40: | Line 47: | ||
==References== | ==References== | ||
<references/> | <references/> | ||
Revision as of 13:58, 18 July 2015
Background
- Occurrence
- 50% within first 2 weeks of placement
- 70% within 2 months of placement
- 80% within 6 months of placement
- 10% present >1 year after surgery
Types
- External Infection
- Involve the subcutaneous tract around the shunt
- Internal Infection
- Involves the shunt and CSF contained within the shunt
Bacteriology
- 50% of cases caused by S. epidermidis
- Also caused by S. aureus, Gram-negatives, anaerobes
Clinical Features
- Internal Infection
- Mental status changes, HA, N/V, irritability
- Neck stiffness (33% of pts)
- Fever is often absent
- Abdominal pain (VP shunt)
- External Infection
- Swelling, erythema, tenderness along site of shunt tubing
Differential Diagnosis
Ventriculoperitoneal shunt problems
- Ventriculoperitoneal shunt obstruction
- Ventriculoperitoneal shunt overdrainage (Slit Ventricle Syndrome)
- Ventriculoperitoneal shunt infection
- Ventriculoperitoneal shunt mechanical failure
Diagnosis
Management
- Emergent neurosurgical consultation and admission
- Shunt tap
- LP often misses CSF shunt infections and has no role when shunt infection is suspected
- Imaging
- Useful to exclude mechanical shunt malfunction (often coexists w/ infection)
- Antibiotics