How long should cerebrospinal fluid cultures be held to detect shunt infections?

Clinical article

Atman DesaiDivision of Pediatric Neurosurgery, Children's Hospital at Dartmouth; and

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Stuart Scott LollisDivision of Pediatric Neurosurgery, Children's Hospital at Dartmouth; and

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Symeon MissiosDivision of Pediatric Neurosurgery, Children's Hospital at Dartmouth; and

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Tarek RadwanDivision of Pediatric Neurosurgery, Children's Hospital at Dartmouth; and

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Deborah E. ZuaroDepartment of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire

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Joseph D. SchwarzmanDepartment of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire

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Ann-Christine DuhaimeDivision of Pediatric Neurosurgery, Children's Hospital at Dartmouth; and

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Object

Infections of CSF hardware may be indolent, and some patients have received antibiotic treatment for various reasons before CSF is obtained to check for a shunt infection. At present, there are few data in the literature to guide the decision as to how long to hold CSF specimens when attempting to diagnose hardware infections, and institutions vary in the duration at which cultures are considered “final.”

Methods

The authors reviewed the microbiology data from CSF specimens obtained from shunts, ventriculostomies, reservoirs, and lumbar drains at their institution over a 36-month period to discover how long after collection cultures became positive. The authors also sought to discover whether this time was affected by prior treatment with antibiotics.

Results

Of 158 positive CSF specimens obtained from hardware, the time to recovery ranged between 1–10 days, with a mean of 3.02 days (SD 2.37 days, 95% CI 2.66–3.38 days). One hundred and twenty-seven positive specimens were associated with clinical infections, and ~ 25% of these grew organisms after > 3 days, with some as long as 10 days after specimens were obtained. The most common organisms grown from individual patients were coagulase-negative Staphylococcus spp (34 cultures), Propionibacterium spp (21), Bacillus spp (6), Pseudomonas aeruginosa (4), and Staphylococcus aureus (4 cultures). Mean and maximum days to recovery were different across species, with S. aureus showing the shortest and Propionibacterium spp showing the longest incubation times. There appeared to be no significant difference in the time to recovery between specimens obtained in patients who had received prior antibiotic treatment versus those who had not.

Conclusions

A substantial number of positive CSF specimens obtained in patients with clinical infections grew bacteria after > 3 days, with some requiring as long as 10 days. Thus, a routine 10-day observation period for CSF specimens can be justified.

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