561. Ventricular Shunt Infections: Effects of Peri-Operative Antimicrobial Regimen on Etiology, Susceptibility and Response to Treatment
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Purpose: The aim of this study is to describe the circumstances surrounding ventricular shunt infections in pediatric patients at Arkansas Children’s Hospital including peri-operative antimicrobial prophylaxis regimens.
Methods: Records of the infectious disease consult service were reviewed from 2003-2008 to identify 61 cases of ventricular shunt infection. Several variables associated with the clinical presentation and management of these infections were collected and reviewed. This study is IRB approved.
Results: The majority of the infections occurred in patients with ventriculoperitoneal shunts who were less than 1 year of age. Most patients had undergone shunt revision within 2 months prior to infection (72%). Patients presented with fever (70%), irritability (50%) and emesis (31%). Significant cerebrospinal fluid derangements were noted in many patients, including elevated WBC counts (>20) in 67% and elevated protein levels (>100) in 64%. Staphylococci were the most common causative organism, with 46% of infections caused by coagulase-negative staphylococci (CONS) and 18% by S. aureus. In the early study period (2003-2004), most patients received cefazolin for antibiotic prophylaxis. With the emergence of methicillin-resistant (MR) organisms, vancomycin became the most commonly used peri-operative antibiotic. Increasing numbers of infections caused by methicillin-susceptible (MS) organisms were observed in patients receiving vancomycin prophylaxis. Patients who received vancomycin prophylaxis were slower to resolve methicillin-resistant infections requiring vancomycin for treatment than those who received peri-operative cefazolin.
Conclusions: Changes in antimicrobial susceptibility of ventricular shunt infections are temporally associated with shifts in peri-operative antimicrobial regimens. With the change to vancomycin as the preferred agent, methicillin susceptible Staphylococcus aureus infections have become more prevalent. Patients treated peri-operatively with vancomycin have been slower to resolve shunt infections despite appropriate therapy.
Jessica Nichols, MD, University of Arkansas for Medical Sciences, Little Rock, AR, Stephanie Stovall, MD, Arkansas Children's Hospital, Little Rock, AR and  J. R. Nichols, None..
S. H. Stovall, None.