Persistant High Cerebrospinal Fluid Protein May Be a Risk Factor for Ventriculoperitoneal Shunt Reinfection in Children

Abstract

Background. Ventriculoperitoneal shunt (VPS) is the most common approach among medical and surgical treatment modalities for treating hydrocephalus. However, VPS infection is a common and serious complication with increased mortality and morbidity. The main purpose of this study was to investigate causative agents, the management of VPS infections and to identify risk factors for re-infection in children. Methods. A retrospective, multicenter study of 290 patients with VP shunt infection was performed at neurosurgery departments in 4 tertiary medical centers in Turkey between January 2011 and September 2014. Results. A total of 290 patients with VPS infections were detected during the study period. Median age of cases was 10.5 months (range 1 to 204 months), of whom 129 (44.5%) were females. The median age of the patients at the time of shunt insertion and first shunt revision were 2 months (range 10 days to 194 months) and 5 months (range 25 days to 168 months), respectively. The etiology of hydrocephalus was congenital malformation in 190 of 290 patients (65.5%). The most common symptom of shunt infection was fever in 108 (37.2%) cases. Median values and ranges of CSF glucose, protein level and number of white blood cell count were 31 mg/dl (range 1 to 269), 159 mg/dl (range 5 to 7240) and 100/mm3, (range 0 to 80,200), respectively. At least one pathogen was identified in 142 of 290 VP shunt infections (48.9%). The most common isolated pathogen was coagulase-negative staphylococci whis grew in 56 cases (44.3%) followed by Pseudomonas aeruginosa in 22 cases (15.4%) and Klebsiella pneumoniae in 15 cases (10.5%). The median time of VPS infection was 2 months (range, 15 days to 60 months) after insertion of shunt catheter, half (49.8%) occured during the first 1st month. VPS infection was treated by antibiotics and shunt removal in 211 cases (76.4%) and only antibiotics in 65 patients (23.5%) without shunt removal. The median duration of antibiotic therapy was 22 days (range 7 to 101 days). Among the potential risk factors for re-infection prior to VSP insertion, CSF protein level more than 100 mg/dl was associated with re-infection (OR, 1.65; p = 0.01). Conclusion. Infection is the most common complication with increased morbidity and mortality. High protein levels (>100 mg/dl) before re-insertion of VP shunt may be a risk factor for VP shunt re-infection.