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Şahin Y, Sayın E, Aslan Y, Bayri Y. Comparative analysis of linezolid, vancomycin, and hyperbaric oxygen therapies in a rat model of ventriculoperitoneal shunt infection. Childs Nerv Syst 2024; 40:1765-1769. [PMID: 38316673 DOI: 10.1007/s00381-024-06305-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 01/27/2024] [Indexed: 02/07/2024]
Abstract
PURPOSE Staphylococcus epidermidis is the most common causative microorganism of ventriculoperitoneal shunt infections. This study aimed to compare linezolid and vancomycin treatments and to examine the effect of these antibiotics alone and combined with hyperbaric oxygen therapy on the amount of bacterial colonies in the experimental S. epidermidis shunt infection model. METHODS A shunt catheter was placed in the cisterna magna of 49 adult male Wistar albino rats. The rats were randomly divided into seven groups, as follows: sterile control, infected control, vancomycin, linezolid, hyperbaric oxygen, vancomycin + hyperbaric oxygen, linezolid + hyperbaric oxygen. In all groups except the sterile control group, 0.2 ml 107 CFU/mL S. epidermidis was inoculated to the cisterna magna. Parenteral vancomycin was administered 40 mg/kg/day to the vancomycin groups, and 50 mg/kg/day of enteral linezolid to the linezolid groups. Hyperbaric oxygen groups were given 100% oxygen at a pressure of 2.4 ATA for 50 min a day. One day after the last treatment, colony quantities in the shunt catheters and CSF were analyzed. RESULTS The number of CSF colonies in the linezolid group was significantly lower than in the vancomycin group (p < 0.05). The number of CSF colonies in the linezolid + HBO group was significantly lower than in the vancomycin + HBO group (p < 0.05). CONCLUSIONS Linezolid treatment was found to be more effective than vancomycin in ventriculoperitoneal shunt infection caused by S. epidermidis. There was no statistical difference among other treatment groups. Hyperbaric oxygen therapy is shown to contribute to the sterilization of cultures.
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Affiliation(s)
- Yener Şahin
- Department of Neurosurgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Elvan Sayın
- Department of Microbiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Yavuz Aslan
- Department of Diving and Hyperbaric Medicine, TR Health Ministry Health Sciences University Istanbul Sultan Abdülhamit Han Training and Research Hospital, Istanbul, Turkey
| | - Yaşar Bayri
- Department of Neurosurgery, Marmara University School of Medicine, Istanbul, Turkey.
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Nergiz S, Aydin Ozturk P. The Prognostic Nutritional Index and Mortality in Patients With Ventriculoperitoneal Shunt Infection. Clin Pediatr (Phila) 2023:99228231209725. [PMID: 37937580 DOI: 10.1177/00099228231209725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
The objective of this study was to investigate the relationship between mortality and the prognostic nutritional index (PNI) in the pediatric patient group with ventriculoperitoneal shunt (VPS) infection. A total of 63 pediatric patients with a VPS infection and positive cerebrospinal fluid (CSF) culture were retrospectively registered. The CSF specimens were analyzed to conduct culture and microscopic evaluation. A total of 44.4% of the cases were men and 55.6% of the cases were women. Patients were divided into 2 groups (survivor and non-survivor patients). When survivor and non-survivor patients were compared, it was found that CSF leukocytes, CSF glucose, CSF protein, CSF/blood glucose ratio, lymphocyte, albumin, and PNI levels were lower in the non-survivor patients' group. Nevertheless, blood glucose and CRP (C-reactive protein) were significantly higher in the non-survivor patients' group than in the survivor patients' group. In our investigation, we suggested that low PNI was related to high mortality in cases of VPS infection.
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Affiliation(s)
- Sebnem Nergiz
- Department of Nutrition and Dietetics, Ataturk Faculty of Health Sciences, Dicle University, Diyarbakir, Turkey
| | - Pinar Aydin Ozturk
- Department of Nutrition and Dietetics, Ataturk Faculty of Health Sciences, Dicle University, Diyarbakir, Turkey
- Department of Neurosurgery, Diyarbakir Gazi Yasargil Education and Research Hospital, Health Sciences University of Turkey, Diyarbakir, Turkey
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Nergiz S, Aydin Ozturk P. Relationship between catheter related cerebrospinal fluid infections and systemic immune-inflammation index. PeerJ 2023; 11:e15905. [PMID: 37701835 PMCID: PMC10493082 DOI: 10.7717/peerj.15905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/25/2023] [Indexed: 09/14/2023] Open
Abstract
Background This study investigated the relationship between the systemic immune inflammation index (SII) and catheter-related infections and their effects on prognosis in pediatric patients. Methods A total of 56 pediatric patients diagnosed with ventriculoperitoneal (V-P) shunt infection between January 2017 and October 2019 were included. V-P shunt infection diagnosis was made based on clinical findings. All cerebrospinal fluid (CSF) samples were subjected to direct microscopic examination and culture. Protein, glucose, and sodium levels in CSF, CSF leukocytes, and hematological and biochemical parameters were measured. Results Fifty-six patients with growth in CSF culture were included in this study. 55.4% of the cases were female and 44.6% male. V-P shunt was detected in 82.1% of the cases and external ventricular drainage (EVD) catheter-related infection in 17.9%. The CSF/blood glucose ratio was significantly lower (p = 0.046), and SII was significantly increased (p = 0.002) in non-coagulase-negative staphylococci. Conclusions Early and appropriate antibiotic therapy reduces morbidity and mortality in catheter-related infections. However, it is important to start empirical antibiotherapy until culture results are expected. Therefore, further research on the estimation of possible factors is needed.
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Affiliation(s)
- Sebnem Nergiz
- Department of Dietetics and Nutrition, Dicle University, Ataturk Faculty of Health Sciences, Diyarbakir, Turkey
| | - Pinar Aydin Ozturk
- Department of Neurosurgery, Health Sciences University of Turkey, Diyarbakır Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
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Yaeger K, Mocco J. Future Directions of Endovascular Neurosurgery. Neurosurg Clin N Am 2022; 33:233-239. [DOI: 10.1016/j.nec.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Karasin B, Eskuchen L, Hardinge T, Watkinson J, Grzelak M, Boyce M. Laparoscopic-Assisted Ventriculoperitoneal Shunt Placement: A Less Invasive Approach to Treating Hydrocephalus. AORN J 2021; 114:133-146. [PMID: 34313999 DOI: 10.1002/aorn.13467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/01/2021] [Accepted: 02/08/2021] [Indexed: 11/07/2022]
Abstract
Hydrocephalus is caused by the disruption of the normal flow of cerebrospinal fluid (CSF), which results in a buildup of CSF. Hydrocephalus comprises two key categories: communicating and noncommunicating. Normal-pressure hydrocephalus, a type of communicating hydrocephalus, currently has no cure; the main treatment option is ventriculoperitoneal shunt (VPS) placement surgery. This procedure is performed to reestablish the balance between CSF production, flow, and absorption. Recently, general surgeons have begun assisting the neurosurgeon by placing the distal or abdominal end of the shunt using a laparoscopic technique. This article briefly reviews the pathophysiology and treatment options for hydrocephalus; presents a thorough review of the laparoscopic-assisted VPS placement procedure, as well as the expected perioperative course and care considerations; and concludes with a case study of a 68-year-old patient who undergoes a laparoscopic-assisted VPS placement.
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Talepour N, Hadi M, Nasseri S, Jaafarzadeh Haghighi Fard N, Mesdaghinia A, Borji SH. Isolation, identification and reviewing the health effect of HPC bacteria in household point-of-use (PoU) water treatment devices: a case study, Ahvaz, Iran. JOURNAL OF ENVIRONMENTAL HEALTH SCIENCE & ENGINEERING 2021; 19:59-69. [PMID: 34150218 PMCID: PMC8172727 DOI: 10.1007/s40201-020-00577-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 10/20/2020] [Indexed: 06/12/2023]
Abstract
In Ahwaz, a city in west southern Iran, the majority of households are using Point of Use (PoU) water treatment units. The heterotrophic plate count (HPC) bacteria were isolated from these units while they were mounted on water distribution system in order to determine the variations in HPC and diversity of the bacterial population using polymerase chain reaction (PCR). Results showed that bacterial population regrowth in PoU units could increase HPC exceeding the limit of the 500 CFU/mL in outlet water. In around 70% of the input water samples, the HPC was less than 500 CFU/ml with a mean of 226.7 (CI 95%: 28.1-425.3). HPC in output treated water samples had an increasing trend from the start of the unit operation with a mean of 2416.4 (CI 95%: 1074.9-3757.9). Out of 49 detected bacterial strains, 20 strains were Gram-negative and 29 Gram-positive. Bacillus was the most frequent genes detected in inlet and outlet water samples. Most of the identified bacterial strains were opportunistic pathogens potentially dangerous for immunocompromised population. HPC population in PoU units significantly can be increased during a one-month period of operation, so replacement of the filters must be done regularly.
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Affiliation(s)
- Nastaran Talepour
- Department of Environmental Health Engineering, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, PO Box 1579461357, Ahvaz, Iran
| | - Mahdi Hadi
- Center for Water Quality Research (CWQR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, PO Box 1417993361, Tehran, Iran
| | - Simin Nasseri
- Center for Water Quality Research (CWQR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, PO Box 1417993361, Tehran, Iran
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, PO Box 1417613151, Tehran, Iran
| | - Neamat Jaafarzadeh Haghighi Fard
- Department of Environmental Health Engineering, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, PO Box 1579461357, Ahvaz, Iran
- Environmental Technologies Research Center, Ahvaz Jundishapur University of Medical Sciences, PO Box 6135715751, Ahvaz, Iran
| | - Alireza Mesdaghinia
- Center for Water Quality Research (CWQR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, PO Box 1417993361, Tehran, Iran
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, PO Box 1417613151, Tehran, Iran
| | - Saeedeh Hemmati Borji
- Center for Water Quality Research (CWQR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, PO Box 1417993361, Tehran, Iran
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Yang YN, Zhang J, Gu Z, Song YL. The risk of intracranial infection in adults with hydrocephalus after ventriculoperitoneal shunt surgery: A retrospective study. Int Wound J 2020; 17:722-728. [PMID: 32073232 DOI: 10.1111/iwj.13331] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/04/2020] [Accepted: 02/09/2020] [Indexed: 11/29/2022] Open
Abstract
Infection remains the most significant complication of ventriculoperitoneal shunt (VPS) surgery. The objective of this study was to investigate intracranial infections complicating VPS surgery in adults with hydrocephalus. Patients who underwent VPS surgery for hydrocephalus between 2000 and 2016 were included. Clinical data and follow-up evaluations were examined and analysed retrospectively. A total of 502 patients with hydrocephalus who underwent VPS surgery were included. They were followed up for at least 2 years. Twelve patients with incomplete data were excluded. Four hundred and ninety patients were included in the final analysis. Twenty-five cases of intracranial infection occurred, accounting for 5.1% of patients with VPS surgery. The mean age of the patients was 57.1 ± 10.1 years (range, 39-72 years). The incidence of intracranial infection in patients over 60 years of age was higher than that in patients under 60 years of age (P = .007). Age (P = .007), diabetes (P = .026), skin infection (P = .028), bed-ridden (P = .007), and modified operation (P = .011) were highly correlated with the incidence of intracranial infection. The findings of this retrospective study show that age, diabetes, skin infection, bed-ridden, and modified operation of hydrocephalus significantly and independently correlated with the incidence of infection. Prospective studies are needed to assess the relationship between the incidence of infection and risk factors in patients with hydrocephalus after VPS.
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Affiliation(s)
- Yun-Na Yang
- Department of Neurosurgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jing Zhang
- Department of Neurosurgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zheng Gu
- Department of Neurosurgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Ying-Lun Song
- Department of Neurosurgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Zervos T, Walters BC. Diagnosis of Ventricular Shunt Infection in Children: A Systematic Review. World Neurosurg 2019; 129:34-44. [DOI: 10.1016/j.wneu.2019.05.057] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 05/06/2019] [Accepted: 05/06/2019] [Indexed: 10/26/2022]
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Infections of the Central Nervous System in the Neurocritical Care Unit. Neurocrit Care 2019. [DOI: 10.1017/9781107587908.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Polis B, Polis L, Zeman K, Paśnik J, Nowosławska E. Unexpected eosinophilia in children affected by hydrocephalus accompanied with shunt infection. Childs Nerv Syst 2018; 34:2399-2405. [PMID: 30032408 PMCID: PMC6224006 DOI: 10.1007/s00381-018-3908-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 07/06/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of the article is to describe an immunological reaction to shunt infection in children with hydrocephalus. The main cause of shunt infection involves methicillin resistant Staphylococcus epidermidis (Bhatia et al. Indian J Med Microbiol 35:120-123, 2017; Hayhurst et al. Childs Nerv Syst 24:557-562, 2008; Martínez-Lage et al. Childs Nerv Syst 26: 1795-1798, 2010; Simon et al. PLoS One, 2014; Snowden et al. PLoS One 8:e84089, 2013; Turgut et al. Pediatr Neurosurg 41:131-136, 2005), a bacterial strain which is responsible for the formation of biofilm on contaminated catheters (Snowden et al. PLoS One 8:e84089, 2013; Stevens et al. Br J of Neurosurg 26: 792-797, 2012). METHODS The study group involved 30 children with congenital hydrocephalus after shunt system implantation, whose procedures were complicated by S. epidermidis implant infection. Thirty children with congenital hydrocephalus awaiting their first-time shunt implantation formed the control group. The level of eosinophils in peripheral blood was assessed in both groups. Cerebrospinal fluid (CSF) was examined for protein level, pleocytosis, interleukins, CCL26/Eotaxin-3, IL-5, IL-6, CCL11/Eotaxin-1, CCL3/MIP-1a, and MBP. Three measurements were performed in the study group. The first measurement was obtained at the time of shunt infection diagnosis, the second one at the time of the first sterile shunt, and the third one at the time of shunt reimplantation. In the control group, blood and CSF samples were taken once, at the time of shunt implantation. RESULTS In the clinical material, the highest values of eosinophils in peripheral blood and CSF pleocytosis were observed in the second measurement. It was accompanied by an increase in the majority of analyzed CSF interleukins. CONCLUSION CSF pleocytosis observed in the study group shortly after CSF sterilization is presumably related to an allergic reaction to Staphylococcus epidermidis, the causative agent of ventriculoperitoneal shunt infection.
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Affiliation(s)
- Bartosz Polis
- Department of Neurosurgery, Polish Mother’s Memorial Hospital Research Institute, Rzgowska st 281/289, 93-338 Łódź, Poland
| | - Lech Polis
- Department of Neurosurgery, Polish Mother’s Memorial Hospital Research Institute, Rzgowska st 281/289, 93-338 Łódź, Poland
| | - Krzysztof Zeman
- Department of Pediatrics and Immunology with Nephrology Unit, Polish Mother’s Memorial Hospital Research Institute, Rzgowska st 281/289, 93-338 Łódź, Poland
| | - Jarosław Paśnik
- Department of Pediatrics and Immunology with Nephrology Unit, Polish Mother’s Memorial Hospital Research Institute, Rzgowska st 281/289, 93-338 Łódź, Poland
| | - Emilia Nowosławska
- Department of Neurosurgery, Polish Mother's Memorial Hospital Research Institute, Rzgowska st 281/289, 93-338, Łódź, Poland.
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Suen K, Mashhadian A, Figarsky I, Payumo J, Liu A. A rare and important case of Staphylococcus haemolyticus-associated ventricular atrial shunt nephritis. Clin Case Rep 2017; 5:2012-2016. [PMID: 29225846 PMCID: PMC5715587 DOI: 10.1002/ccr3.1251] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 05/31/2017] [Accepted: 09/13/2017] [Indexed: 11/11/2022] Open
Abstract
Shunt nephritis is a rare and relatively new diagnosis involving glomerular kidney damage following ventriculoperitoneal and ventriculoatrial shunt placement. Our case report summarizes the presentation, diagnostic workup, and management of a patient with shunt nephritis. We also review and discuss the current literature on the topic.
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Affiliation(s)
- Kyle Suen
- California Hospital Medical Center 1401 S Grand Ave Los Angeles California 90015 USA
| | - Ardavan Mashhadian
- California Hospital Medical Center 1401 S Grand Ave Los Angeles California 90015 USA
| | - Ian Figarsky
- California Hospital Medical Center 1401 S Grand Ave Los Angeles California 90015 USA
| | - Jeff Payumo
- California Hospital Medical Center 1401 S Grand Ave Los Angeles California 90015 USA
| | - Antonio Liu
- California Hospital Medical Center 1401 S Grand Ave Los Angeles California 90015 USA
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12
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Martín-Gandul C, Mayorga-Buiza MJ, Castillo-Ojeda E, Gómez-Gómez MJ, Rivero-Garvía M, Gil-Navarro MV, Márquez-Rivas FJ, Jiménez-Mejías ME. Sequential antimicrobial treatment with linezolid for neurosurgical infections: efficacy, safety and cost study. Acta Neurochir (Wien) 2016; 158:1837-43. [PMID: 27520361 DOI: 10.1007/s00701-016-2915-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 08/01/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND Evidence for the effectiveness of linezolid in neurosurgical infections (NSIs) is growing. The comfortable oral dosage and tolerance of linezolid opens the possibility for sequential antimicrobial treatment (SAT) in stable patients after a period of intravenous treatment. METHODS To evaluate the efficacy and safety of SAT with oral linezolid in patients with NSI and to analyse the cost implications, an observational, non-comparative, prospective cohort study was conducted on clinically stable consecutive adult patients at the Neurosurgical Service. Following intravenous treatment, patients were discharged with SAT with oral linezolid. RESULTS A total of 77 patients were included. The most common NSIs were: 41 surgical wound infections, 20 subdural empyemas, 18 epidural abscesses, and 16 brain abscesses. Forty-four percent of patients presented two or more concomitant NSIs. Aetiological agents commonly isolated were: Propionibacterium acnes (36 %), Staphylococcus aureus (23 %), Staphylococcus epidermidis (21 %) and Streptococcus spp. (13 %). The median duration of the SAT was 15 days (range, 3-42). The SAT was interrupted in five cases due to adverse events. The remainder of the patients were cured at the end of the SAT. A total of 1,163 days of hospitalisation were saved. An overall cost reduction of €516,188 was attributed to the SAT. Eight patients with device infections did not require removal of the device, with an additional cost reduction of €190,595. The mean cost saving per patient was €9,179. CONCLUSIONS SAT with linezolid was safe and effective for the treatment of NSI. SAT reduces hospitalisation times, which means significant savings of health and economic resources.
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Ramos TN, Arynchyna AA, Blackburn TE, Barnum SR, Johnston JM. Soluble membrane attack complex is diagnostic for intraventricular shunt infection in children. JCI Insight 2016; 1:e87919. [PMID: 27699221 DOI: 10.1172/jci.insight.87919] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Children treated with cerebrospinal fluid (CSF) shunts to manage hydrocephalus frequently develop shunt failure and/or infections, conditions that present with overlapping symptoms. The potential life-threatening nature of shunt infections requires rapid diagnosis; however, traditional microbiology is time consuming, expensive, and potentially unreliable. We set out to identify a biomarker that would identify shunt infection. METHODS CSF was assayed for the soluble membrane attack complex (sMAC) by ELISA in patients with suspected shunt failure or infection. CSF was obtained at the time of initial surgical intervention. Statistical analysis was performed to assess the diagnostic potential of sMAC in pyogenic-infected versus noninfected patients. RESULTS Children with pyogenic shunt infection had significantly increased sMAC levels compared with noninfected patients (3,211 ± 1,111 ng/ml vs. 26 ± 3.8 ng/ml, P = 0.0001). In infected patients undergoing serial CSF draws, sMAC levels were prognostic for both positive and negative clinical outcomes. Children with delayed, broth-only growth of commensal organisms (P. acnes, S. epidermidis, etc.) had the lowest sMAC levels (7.96 ± 1.7 ng/ml), suggesting contamination rather than shunt infection. CONCLUSION Elevated CSF sMAC levels are both sensitive and specific for diagnosing pyogenic shunt infection and may serve as a useful prognostic biomarker during recovery from infection. FUNDING This work was supported in part by the Impact Fund of Children's of Alabama.
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Affiliation(s)
| | - Anastasia A Arynchyna
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Children's of Alabama
| | | | - Scott R Barnum
- Department of Microbiology.,Department of Neurology, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - James M Johnston
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Children's of Alabama
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Khalil A, Mandiwanza T, Zakaria Z, Crimmins D. Routine cerebrospinal fluid analysis during ‘de novo’ ventriculoperitoneal shunt insertion: Single Institution Experience. Br J Neurosurg 2016; 30:427-8. [DOI: 10.3109/02688697.2015.1119235] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Humphreys H, Jenks PJ. Surveillance and management of ventriculitis following neurosurgery. J Hosp Infect 2015; 89:281-6. [PMID: 25687249 DOI: 10.1016/j.jhin.2014.12.019] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 12/23/2014] [Indexed: 11/26/2022]
Abstract
Ventriculitis is an important complication following neurosurgery and is often associated with the use of an external ventricular drain (EVD). The incidence varies from <5% to 20%, partly due to variations in the definitions used for diagnosis. Staphylococci are the most important causes but the isolation of coagulase-negative staphylococci from a cerebrospinal fluid (CSF) sample needs to be interpreted with caution as it may represent contamination. Risk factors for ventriculitis include advanced age, the duration of EVD placement, the number of manipulations and the presence of intraventricular haemorrhage. Prevention strategies increasingly focus on the implementation of a care bundle that includes aseptic technique at the time of insertion and during any manipulations, skin preparation, prophylactic antibiotics, and appropriate dressings at the site of the EVD. The use of EVDs impregnated with antimicrobial agents is increasing but, whereas some studies show that these are effective, it is not clear whether they provide added benefit when there is compliance with other measures. Antimicrobial treatment is challenging as many widely used agents do not penetrate into the CSF and causative bacteria are increasingly multidrug resistant. Often a combination of high-dose intravenous and intraventricular agents is required, especially for Gram-negative infections. Large trials in this area are challenging to conduct; therefore, to better inform preventive strategies and to optimize management of this important condition, ongoing national surveillance and pooling of data on treatment approaches and outcomes are needed.
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Affiliation(s)
- H Humphreys
- Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Microbiology, Beaumont Hospital, Dublin, Ireland.
| | - P J Jenks
- Department of Microbiology, Plymouth Hospitals NHS Trust, Plymouth, UK
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Mullan E, Lucas C, Mackie S, Carachi R. Audit of ventriculoperitoneal shunt infections in paediatric patients, 2006–2013. Scott Med J 2014; 59:198-203. [DOI: 10.1177/0036933014548665] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Infection following ventriculoperitoneal shunt placement remains a significant complication with an incidence of 3–27% cited in literature. Infections cause significant morbidity, and it is important that empirical antibiotic therapy for management is guided by accurate knowledge of prevailing aetiologies and local antibiotic sensitivity patterns. Aims To establish the incidence of shunt infections in our paediatric population, to identify the causative micro-organisms, and to determine the antibiotic resistance patterns of the responsible micro-organisms. Methods Retrospective data collection utilising existing databases in the Royal Hospital for Sick Children, Yorkhill, between 1 January 2006 and 30 September 2013. Results Total number of shunt operations was 308 with 28 episodes of infection involving 27 patients (male = 12, female = 15). The incidence of infection was 9%. In all, 79% of the episodes involved a single pathogen with 21% being mixed pathogens. Coagulase-negative staphylococci were the most common cause of infection (44%). Gram-positive sensitivity to flucloxacillin and gentamicin was noticeably low at 22% and 14%, respectively with 87% of coagulase-negative staphylococci resistant to gentamicin and 81% resistant to flucloxacillin. Conclusions The changing spectrum of Gram-positive organisms has impacted on antibiotic sensitivity patterns, and our local prescribing policy has been adapted in order to manage shunt infections most effectively.
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Affiliation(s)
- Emily Mullan
- Paediatric Trainee Doctor, Department of Paediatric Surgery, Royal Hospital for Sick Children, UK
| | - Carol Lucas
- Principal Clinical Scientist, Department of Microbiology, Royal Hospital for Sick Children, UK
| | - Sarah Mackie
- Speciality Trainee Doctor, Department of Paediatric Surgery, Royal Hospital for Sick Children, UK
| | - Robert Carachi
- Professor of Surgical Paediatrics, Department of Paediatric Surgery, Royal Hospital for Sick Children, UK
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Gutierrez-Murgas Y, Snowden JN. Ventricular shunt infections: immunopathogenesis and clinical management. J Neuroimmunol 2014; 276:1-8. [PMID: 25156073 DOI: 10.1016/j.jneuroim.2014.08.006] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 07/17/2014] [Accepted: 08/06/2014] [Indexed: 12/22/2022]
Abstract
Ventricular shunts are the most common neurosurgical procedure performed in the United States. This hydrocephalus treatment is often complicated by infection of the device with biofilm-forming bacteria. In this review, we discuss the pathogenesis of shunt infection, as well as the implications of the biofilm formation on treatment and prevention of these infections. Many questions remain, including the contribution of glia and the impact of inflammation on developmental outcomes following infection. Immune responses within the CNS must be carefully regulated to contain infection while minimizing bystander damage; further study is needed to design optimal treatment strategies for these patients.
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Affiliation(s)
- Yenis Gutierrez-Murgas
- Department of Pathology & Microbiology, University of Nebraska Medical Center, 985900 Nebraska Medical Center, Omaha, NE 68198-5900, USA.
| | - Jessica N Snowden
- Department of Pathology & Microbiology, University of Nebraska Medical Center, 985900 Nebraska Medical Center, Omaha, NE 68198-5900, USA; Department of Pediatrics, University of Nebraska Medical Center, 985900 Nebraska Medical Center, Omaha, NE 68198-5900, USA.
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A Fifteen-year Epidemiological Study of Ventriculoperitoneal Shunt Infections in Pediatric Patients: A Single Center Experience. ACTA ACUST UNITED AC 2012. [DOI: 10.14776/kjpid.2012.19.3.141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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