Characteristics of 59 children with cerebrospinal fluid shunt infections
| Characteristics | Standard shunt (n=14) | Antibiotic shunt (n=45) | P value |
| Female, n (%) | 5 (36) | 18 (40) | >0.99 |
| Preterm birth, n (%) | 5 (36) | 27 (60) | 0.20 |
| Age at shunt placement (years), median (IQR) | 1.0 (0.29–11) | 0.38 (0.13–2.3) | 0.11 |
| Age at shunt infection (years), median (IQR) | 3.1 (0.72–13) | 0.58 (0.38–5.5) | 0.11 |
| Interval from shunt placement to infection (days), median (IQR) | 60 (20–380) | 40 (24–77) | 0.70 |
| Infections in first 31 days after shunt placement, n (%) | 6 (43) | 13 (29) | 0.52 |
| Signs and symptoms, n (%) | |||
| Fever (≥38.2°C) in hospital | 10 (71) | 23 (51) | 0.23 |
| History of fever at home | 3 (21) | 7 (16) | 0.69 |
| Nausea | 1 (7.1) | 3 (6.7) | >0.99 |
| Vomiting | 4 (29) | 16 (36) | 0.75 |
| Seizures | 1 (7.1) | 2 (4.4) | 0.56 |
| Other neurological symptoms | 2 (14) | 6 (13) | >0.99 |
| Irritability | 3 (21) | 16 (36) | 0.51 |
| Lethargy | 4 (29) | 10 (22) | 0.72 |
| Poor feeding | 2 (14) | 10 (22) | 0.71 |
| Abdominal pain | 4 (29) | 4 (8.9) | 0.081 |
| Pathogen, n (%) | 0.47 | ||
| Coagulase negative staphylococci | 6 (43) | 13 (29) | |
| Staphylococcus aureus (methicillin susceptible) | 1 (7) | 7 (16) | |
| Staphylococcus aureus (methicillin resistant) | 1 (7) | 2 (4) | |
| Cutibacterium acnes | 2 (14) | 1 (2) | |
| Enterococcus faecalis | 0 (0) | 2 (4) | |
| Other Gram positive* | 1 (7) | 4 (9) | |
| Pseudomonas aeruginosa | 0 (0) | 3 (7) | |
| Other Gram negative† | 0 (0) | 6 (13) | |
| Candida spp‡ | 1 (7) | 1 (2) | |
| Polymicrobial | 2 (14) | 6 (13) | |
| CSF parameters | |||
| CSF WBC count (cells/µL), median (IQR) | 69 (31–250) | 54 (9–420) | >0.99 |
| Proportion neutrophils (%), median (IQR) | 45 (4.5–63) | 42 (12–79) | 0.58 |
| Shunt procedures, n (%) | 0.61 | ||
| Shunt removed, EVD placed, and shunt later replaced | 10 (71) | 30 (67) | |
| Shunt removed, EVD placed, and shunt never replaced | 1 (7) | 6 (13) | |
| Shunt externalized and externalized part eventually replaced | 1 (7) | 2 (4) | |
| Shunt removed and not replaced | 0 | 4 (9) | |
| Infected shunt retained | 0 | 1 (2) | |
| Other§ | 2 (14) | 2 (4) | |
| Outcomes, n (%) | |||
| Complication | 7 (50) | 18 (40) | 0.73 |
| ICU admission | 5 (36) | 20 (44) | 0.79 |
| Duration of hospitalization (days), median (IQR)¶ | 34 (20–51) | 26 (14–47) | 0.35 |
| Fatal outcome | 1 (7.1) | 2 (4.4) | 0.56 |
Numbers represent n (%) unless otherwise indicated.
*Streptococcus mitis complex (n=2); Group B streptococcus (n=1); S. dysgalactiae (n=1); Bacillus spp (n=1).
†Enterobacter cloacae (n=2); Klebsiella aerogenes (n=1); E. coli (n=1); Acinetobacter spp. (n=1); Klebsiella oxytoca (n=1).
‡C. parapsilosis (n=1); C. lusitaniae (n=1).
§New shunt placed at time of removal of original shunt (n=1); shunt externalized then removed without replacing it (n=1); shunt removed and EVD placed, EVD infected and removed (n=1); shunt removed completely and eventually replaced 19 days later (n=1).
¶Among survivors (n=56).
CSF, cerebrospinal fluid; EVD, external ventricular drain; ICU, intensive care unit; IQR, interquartile range; WBC, white blood cell.