Mirajus Siraj, Samina Iltaf, Roohina Saeed.
Management of ventriculo-peritoneal shunt infections.
J Surg Pak Jan ;16(3):114-7.

Objective To analyze etiology, clinical features, pathogens, mortality and morbidity, and modalities of treatment for ventriculo-peritoneal (VP) shunt infections. Study design Descriptive case series. Place & Duration of study Study was carried out in the department of Neurosurgery, Foundation University Medical College Rawalpindi, from June 2003 to June 2008. Methodology The record of 5 year period was reviewed. The data were evaluated for etiology of hydrocephalus, age, clinical features, microbiological parameters, management and clinical outcome of VP shunt infections. Results A total of 149 patients were operated for ventriculo-peritoneal shunt. Majority (n 128 – 86%) were below the age of 5 years. Twenty-one (14 %) of the operated patients were admitted with symptoms of shunt infection. Four (19%) of the infected patients had throat infection/gastroenteritis rather than shunt infection. Six (29%) patients were treated conservatively with intravenous antibiotics. Eleven (52%) of the infected patients had removal of shunt and insertion of external ventricular drain (EVD) with periodic CSF sampling and culture sensitivity (CS) and delayed shunt replacement. Five (3.3%) of VP shunt patients died with shunt infection and septicemia. Commonest causative microorganism identified were staphylococcus epidermidis, staphylococcus aureus and gram negative bacilli. Conclusions: The most common bacteria isolated were gram positive organisms. In cases with VP shunt infection it is essential to remove VP shunt and start systemic antibiotics.

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