Ventricular shunt infection

Background

Microbiology

• Enterobacteriaceae
• Pseudomonas aeruginosa
• Staphylococcus aureus
• Coagulase-negative staphylococci
• Candida species

Pathophysiology

• Four mechanisms of infection:
  • Colonization at time of surgery progressing to infection
  • Retrograde infection from distal end (for ventriculoperitoneal shunts)
  • Transcutaneous (erosion or manipulation)
  • Hematogenous spread (especially for ventriculoatrial shunts)

Clinical Manifestations

• Headache, nausea, lethargy, and altered mental status
• May have erythema and tenderness over the tubing
• May have abdominal pain if peritoneal source for VP shunt
• Can present with isolated fever

Further Reading

• 2017 Infectious Diseases Society of America's Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis. Clin Infect Dis. 2017;64(6):e34-e65. doi: 10.1093/cid/ciw861