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David B. Shurtleff, Dennis Christie and Eldon L. Foltz

V entriculitis and septicemia have been recognized as complications of ventriculoauricular cerebrospinal fluid shunts since 1959 2, 7, 20, 29, 30, 32 Despite reports of an incidence of from 6% to 23% in a number of series, 2, 5, 7, 10, 11, 20, 21, 23, 26, 29–32, 38 no accurate estimate exists for a postoperative infection rate in a patient group closely observed over a long period of time. 5 Our experience over a 12-year period with 299 operative procedures in 102 newly referred and uninfected patients (age 1 day to 37 years) suggests that infection is a

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Cerebrospinal fluid shunt infection

Influences on initial management and subsequent outcome

Beverly C. Walters, Harold J. Hoffman, E. Bruce Hendrick and Robin P. Humphreys

N o entity accounts for more mortality and morbidity among patients with cerebrospinal fluid (CSF) shunts than infection. Death, intellectual and neurological deficit, and astronomical costs in terms of health care funds and human suffering are the usual sequelae. For these reasons, the management of shunt infection is of great concern to the neurosurgical community. In order to gain some perspective on this matter, an examination was undertaken of efforts at the Hospital for Sick Children (HSC) in Toronto, Canada, in the treatment of CSF shunt infections

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Factors causing acute shunt infection

Computer analysis of 1174 operations

Dominique Renier, Jacques Lacombe, Alain Pierre-Kahn, Christian Sainte-Rose and Jean-François Hirsch

I nfection remains the foremost complication associated with shunt procedures for hydrocephalus. The incidence varies up to 20%, but most rates are in the range of 7% to 10%. 2, 7, 9, 12, 14, 17 Many studies emphasize the frequency of infection in either ventriculoatrial or ventriculoperitoneal shunts, but few authors have precisely identified the factors that may cause it. 7, 21, 23, 24 Since 1975, a surgical isolator has been used for shunting procedures at Hôpital des Enfants Malades in Paris. The rate of postoperative infections has been reduced by this

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Diphtheroid infections of cerebrospinal fluid shunts

The changing pattern of shunt infection in Cleveland

Harold L. Rekate, Teresa Ruch and Frank E. Nulsen

S hunt infection has been the major cause of morbidity and mortality in patients with cerebrospinal fluid (CSF) shunts. Reported rates of infection vary widely, and are as high as 22% in some series. 16 Several recent reports have shown considerable reductions in rates of infection when all shunts in the same institution are performed by the same surgeon with strict attention to asepsis, time of procedure, and the use of prophylactic antibiotics. 19 Shunt infection leads to prolonged hospital stay, numerous surgical procedures, and increased risk of

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Matthew R. Test, Kathryn B. Whitlock, Marcie Langley, Jay Riva-Cambrin, John R. W. Kestle and Tamara D. Simon

C erebrospinal fluid (CSF) shunts are critical to the surgical management of hydrocephalus. 12 However, complications are common, with CSF shunt infection occurring in 6%–20% of patients with shunts. 3 , 4 , 11 , 20 , 21 , 23 Despite this high rate of infection, there has been limited study of the presentation of shunt infections. CSF shunt infections are caused by a variety of pathogens, including coagulase-negative Staphylococcus (CONS), Staphylococcus aureus , gram-negative organisms, and anaerobes. 2 , 15 Among these pathogens, anaerobes and gram

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Infection after depressed fracture of skull

Implications for management of nonmissile injuries

Bryan Jennett and J. Douglas Miller

D epressed fracture of the skull due to nonmissile injury is usually followed by rapid and complete recovery provided that management is appropriate. However, one in four such patients in our previously reported series had a major complication, either infection, intracranial hematoma, or involvement of venous sinuses by the fracture. 11 Infection is in many ways the most important of these complications because it should be possible to prevent it by proper surgical treatment. Yet the infection rate in this civilian series was 10 times as great as that finally

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Atiq-ur Rehman, Tausif-ur Rehman, Hassaan H. Bashir and Vikas Gupta

V entriculoperitoneal shunt surgery is one of the most commonly performed neurosurgical procedures, and despite the 50 years of progress it has seen, shunt infection remains a common cause of shunt dysfunction. Infection rates have not been low and range from 5 to 15%. 1 , 3 , 13 The highest infection rates have been observed during the 1st month of placement, in patients who require serial revisions and in patients who have undergone shunt revision after treatment for infection. 6 Approximately half of all shunt infections are due to coagulase

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Jordan Gruskay, Jeremy Smith, Christopher K. Kepler, Kristen Radcliff, James Harrop, Todd Albert and Alexander Vaccaro

P ostoperative SSIs are one of the most common complications following spine surgery. The incidence of postoperative infection reported after spine surgery is variable, ranging from 0.5% to 20%. 11 , 15 , 25 , 35 , 39 , 43 , 44 These SSIs result in longer hospital stays, a 5-fold risk of hospital readmission, and a 60% higher chance of ICU admission, and are associated with a 2-fold increase in postoperative deaths. 20 , 23 Because of the relatively high incidence and the difficulty of treating SSIs, a thorough understanding of the epidemiology and

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Yuma Okamura, Keisuke Maruyama, Shin Fukuda, Hiroshi Horikawa, Nobuyoshi Sasaki, Akio Noguchi, Motoo Nagane and Yoshiaki Shiokawa

C erebrospinal fluid (CSF) shunt surgeries play an essential role in the treatment of hydrocephalus of various etiologies. 25 Due to the implantation of foreign materials, shunt infections are among the most common surgical complications, frequently causing meningitis or peritoneal infections. 21 Once infections occur, they may result in shunt failure, subsequent disorders of higher cortical function, and more serious sequelae, including death. 11 , 17 The reported rate of infections is 5% to 17%, 3 , 15 , 16 , 20 , 28 and the use of a protocol to prevent

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Hector E. James and John S. Bradley

C erebrospinal fluid shunts are commonly placed to treat hydrocephalus and other conditions, and the most frequent complications are malfunction and infection. The incidence of shunt infection reported in the literature is 1.5–41%, 44 and multiple treatment modalities are currently in use. 1 , 9 , 20 , 36 , 43 , 44 Most authors agree that antibiotic therapy should be administered intravenously to obtain high concentrations of the same in the CSF, but there is very limited consensus as to the duration of therapy, the need for and manner of administration