Microbiology, Treatment, and Outcomes of Ventriculoperitoneal Shunt Infections

INTRODUCTION: Ventriculoperitoneal shunt infection is a serious complication of hydrocephalus treatment and may require prolonged antimicrobial therapy, repeated surgery, and temporary cerebrospinal fluid diversion. This study evaluated the clinical characteristics, microbiological profile, treatment strategies, and outcomes of ventriculoperitoneal shunt infections, with particular emphasis on gram-negative involvement and recurrence.
METHODS: This retrospective cohort study included 36 patients treated for a first documented ventriculoperitoneal shunt infection at a tertiary referral center between January 2016 and December 2023. Demographic, clinical, microbiological, treatment, and outcome data were reviewed. Patients with positive cerebrospinal fluid cultures were compared according to the presence of gram-negative organisms.
RESULTS: Cerebrospinal fluid cultures were positive in 32 patients (88.9%). Staphylococcus species were identified in 68.8%, gram-negative organisms in 43.8%, and polymicrobial infection in 40.6%. Gram-negative involvement was associated with more frequent polymicrobial infection (64.3% vs 22.2%; p = 0.029), longer time to cerebrospinal fluid sterilization (28.5 vs 14.0 days; p = 0.030), and longer hospitalization (60.5 vs 32.0 days; p = 0.026). Recurrent infection occurred in 17 of 35 evaluable patients (48.6%). Positive wound swab cultures were more frequent among patients with recurrence (52.9% vs 11.1%; p = 0.012; unadjusted odds ratio, 9.00).
DISCUSSION AND CONCLUSION: Gram-negative involvement in ventriculoperitoneal shunt infections was associated with a more prolonged treatment course but not with recurrence. Positive wound swab culture may be a marker of recurrent infection. Larger prospective studies are needed to confirm these findings and optimize management strategies.

Keywords: cerebrospinal fluid, gram-negative bacteria, hydrocephalus, recurrence, shunt infection, ventriculoperitoneal shunt