Shunt infections are often the result of contamination of proximal end of the shunt with normal skin flora. Shunt infection is usually caused by a person’s own bacterial organisms and isn’t acquired from other children or adults who are ill. This type of infection is most likely seen one to three months after surgery, but can occur up to six months after the placement of a shunt.
A shunt system can also be placed in the lumbar space of the spine and have the CSF redirected to the peritoneal cavity (Lumbar-peritoneal shunt).
- Staphylococcus epidermidis
- Staphylococcus aureus
- Candida albicans
Shunt infections are most frequently (65%) caused by Coagulase negative Staphylococcus (CoNS)
Gram negative bacteria are the next most frequent pathogens, accounting for 19% to 22% of cases Patients with CSF shunts have an increased risk of meningitis caused by traditional pathogens (S. pneumoniae, N. meningitidis, H. influenzae), often treatable without shunt revision.
- Fever (variable 14-92%), shunt malfunction causing raised intracranial pressure (headache, nausea or vomiting, altered mental status). Traditional meningeal symptoms less common.
- PE: erythema and tenderness of skin over tubing.Proximal shunt involvement: meningitis or ventriculitis (30%), shunt malfunction. Non-communication between ventricle and meninges (i.e., reason for shunt such as aqueductal stenosis) may mean meningeal signs will not develop.
- Distal shunt involvement: ventriculoperitoneal (VP) shunts: abdominal pain, focal or generalized peritonitis, intraabdominal abscess, perforated viscus.
- Ventriculoatrial shunts: sepsis, positive blood cultures, right-sided endocarditis, shunt nephritis, hepatosplenomegaly.