Pelegrin et al reviewed reasons for treatment failure of an infected ventriculoperitoneal (VP) shunt infection. The authors are from Hospital Universitari de Bellvitge-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL) and Hospital Universitario 12 deOctubre, Instituto de Investigación Hospital in Spain.
Rate of infection: 5 to 13%
Strategies used to treat an infected VP shunt:
(1) one-stage shunt replacement plus antibiotics
(2) two-stage shunt replacement plus antibiotics
(3) shunt removal without replacement plus antibiotics
(4) antibiotic therapy only
Patient selection: infected ventriculoperitoneal shunt
Criteria for treatment failure - at least one of the following:
(1) absence of definite CSF sterilization
(2) related mortality
The only independent predictor of treatment failure was retention of the VP shunt.
The only exception to the rule of shunt removal was community-acquired bacterial meningitis which has a good prognosis.
Additional factors to consider:
(1) superinfection of the CSF
(2) shunt dependency
(3) selection of antibiotic therapy and bactericidal profile
