The Diagnosis,Prevention And Treatment Of Ventriculoperitoneal Shunt Infection

Objective: Infection is a serious complication after ventriculoperitoneal shunt (VPS) operation, with high morbidity and mortality. Its early diagnosis is still difficult, and its prevention and treatment are not standardized. The aim of this study was to explore the early diagnosis,prevention and treatment principles of ventriculoperitoneal shunt infection.Methods: Data pertaining to all ventriculoperitoneal shunt procedures conducted at the First Affiliated Hospital of Dalian Medical University since 1995 were reviewed. All patients were divided into two groups by whether undergoing preoperative systemic antistaphylococcal antibiotics therapy. The infection rates of the two groups were compared. At the same time the diagnosis and treatment approaches of 26 cases with infections after ventriculoperitoneal shunt operation were analysised. All the cases were examined by the blood,cerebrospinal fluid (CSF) bacterial culture and imaging examination. The infected shunts were removed in 18 cases firstly, with intraventricular antibiotic treatment and external drainage, and the new shunts were re-implanted when cerebrospinal fluid sterility was achieved. 4 cases with external abdominal shunt firstly, and the infected shunts were removed at right time, the new shunts were re-implanted when cerebrospinal fluid sterility was achieved. 4 cases were administrated by diversion pumps, without removing the shunts. As soon as the diagnosis based on the blood and cerebrospinal fluid bacterial culture and sensitivity test results were definite, intravenous sensitive antibiotics were applicated.Results: Ventriculoperitoneal shunt operations were performed in a total 305 patients, including 26 cases of postoperative infections, and the overall infection rate was 8.5%. The infection rate was 6.8% (9 of 132) in Groupâ… (the cases with preoperative systemic antistaphylococcal antibiotics therapy), the infection rate was 9.8% (17 of 173) in Groupâ…¡(the cases without preoperative systemic anti- staphylococcal antibiotics therapy). No statistic differences were found related to the infection rates between the two groups (p=0.391>0.05). Ventriculoperitoneal shunt infection mostly occurred within 4 months, and the most common pathogenic microorganisms was Staphylococcus epidermidis, followed by Staphylococcus aureus. 2 cases died from complications of shunt infections, 2 cases had a recurrent shunt infection, the new shunts were re-implanted in 21 cases, 3 cases without removing the shunt device were cured. The overall mortality was 7.7% (2 of 26), the cure rate was 92.3% (24/26).Conclusions: The early diagnosis of ventriculoperitoneal shunt infection was very important, some non-specific symptoms and signs should be paid more attention to. How to prevent ventriculoperitoneal shunt infection more effectively needs to be further explored. The cases with postoperative infection should be taken positive measures, the management protocol consisting of the removal of the infected shunt, intraventricular antibiotic treatment and external drainage, and the placement of a new shunt at right time was a valid method. For early infection, conservative treatment was effective.