PEDIATRICS Vol. 59 No. 4 April 1977, pp. 614-618
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Gram-Negative Cerebrospinal Fluid Shunt-Associated Infections

Clifford J. Sells M.D.1, David B. Shurtleff M.D.1, and John D. Loeser M.D.1

1 Department of Pediatrics, the Child Development and Mental Retardation Center, and the Division of Congenital Defects and the Department of Neurological Surgery, University of Washington School of Medicine, and the Children's Orthopedic Hospital and Medical Center, Seattle

Twenty hydrocephalic children with cerebrospinal fluid (CSF) shunts over an 11-year period were seen with Gram-negative central nervous system (CNS) infections. Seventeen infections were with single organisms and three were mixed. Sixteen of 20 (80%) of the infections occurred within five months of shunt surgery. Complete shunt removal or replacement in a new site plus systemic and intraventricular antibiotics resulted in a 100% (9/9) cure rate. Systemic and intraventricular antibiotics alone or in combination with incomplete shunt removal generally were unsuccessful.

Significant morbidity and mortality were associated with these infections. Of the 18 patiens with follow-up data, seven (39%) died with the infection four (22%) sustained definite CNS damaeg, three (17%) were retarded after infection but their preinfection status was unknown, and only four (22%) patients escaped without definite sequelae. Early recognition and appropriate therapy, hopefully, will improve the current bleak prognosis.

Submitted on July 19, 1976
Accepted on October 28, 1976




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[Abstract] [PDF]