Infectious Disease Compendium

VP Shunt Infection (CNS)

Diagnosis

Tap the shunt and the spinal fluid; 20% will have normal studies (PubMed). That is because the fluid in the shunt is separate from the immune system.

For ventricular-atrial shunts, also check blood cultures.

Epidemiologic Risks

Having a shunt? (Review).

Microbiology

Staphylococcus, coagulase-negative (found in 37% of specimens), Staphylococcus aureus (18%), and Propionibacterium acnes (9%), the rest were a variety of gram-negative rods (PubMed). Holding the cultures for two weeks will increase the yield (PubMed).

If you grow a colon organism like an E. coli, the peritoneal end of the shunt has eroded into the bowel. I have seen it 2 or 3 times.

Empiric Therapy

Vancomycin and cefepime or meropenem.

Shunt removal is associated in one large series with the best outcome (PubMed).

Curious Cases

Relevant links to my Medscape blog

In Cultures I Trust

Self-Sealing?

Last Update: 02/10/19.