Intravenous antibiotic therapy effective against shunt infection in children

Use of intravenous antibiotics is sufficient to treat children with ventriculoperitoneal (VP) shunt infections, particularly those infected by Gram-negative organisms and with cerebrospinal fluid (CSF) glucose level of >40 mg/dl, suggests an Iran study.

A total of 148 children (mean age, 21.2 months) were included in the analysis, of whom 56.1 percent were boys and 68.2 percent had responded to the protocol. Patients infected with Gram-negative bacteria (82.9 percent), specifically Acinetobacter spp. and Pseudomonas aeruginosa, showed the most significant response.

Of note, those with CSF glucose >40 mg/dl had significantly higher response to treatment (83 percent vs 58.1 percent; p=0.004).

This retrospective study included children <15 years of age with VP shunt infection, who had undergone treatment from March 2011 to March 2018 in the main referral hospital in Isfahan, Iran. Patients with distal shunt infection or associated wound infection were excluded.

The initial protocol consisted of empiric intravenous antibiotic therapy and repeated evaluation of CSF analysis and culture. Adjustments to antibiotic regimen according to sensitivity results were carried out after obtaining the culture results.

Response to protocol was defined as negative culture results after 72 hours of appropriate antibiotic, which persisted at least for 1 month after discontinuation of therapy. Shunts were replaced in patients who did not respond to the protocol.

“Infection is one of the most common complications of VP shunts,” the authors said, noting that its optimal management remains controversial.