INTRODUCTION : hydrocephalus is the most frequent neurosurgical problem encountered in the paediatric age group with an incidence of 1 in 2000 births. It may also occur as a complication of any insult to the nervous system like infections, Intra-ventricular haemorrhage, brain tumours, and head injury. Cerebrospinal fluid (CSF) shunting is a process by which CSF is diverted from the lateral ventricles to another part of the body for absorption Cerebrospinal fluid diversion devices are essential in the management of this pathology. Ventriculoperitoneal shunt, a device inserted for the treatment of Hydrocephalus results in significant improvement in neurological function and survival of patients. Infection is one of the most serious complications after CSF shunt or external ventricular drain placement. It increases both morbidity and mortality
and causes an increased incidence of seizures and neurological disturbances. A typical CSF shunt comprises of three parts, a proximal portion – Ventricular catheter, which is inserted into the CSF space, a valve and Reservoir and a distal portion – terminating in the peritoneal (ventriculoperitoneal shunt), pleural ventriculopleural shunt) or vascular Space (ventriculoatrial shunt). CSF shunts may become infected by retrograde infection from the distal end, through the skin, by haematogenous seeding or by colonization at
the time of surgery. AIM OF THE STUDY : To isolate the causative organisms. To assess the risk factors associated with shunt infection. To find the incidence of infection associated with shunt related procedures.
To determine the antimicrobial susceptibility pattern of the isolates to aid in management. To evaluate the outcome of management. MATERIALS AND METHODS : This is a cross sectional study involving 397 patients, among whom 275 patients had undergone primary ventriculoperitoneal shunt insertion and
122 patients had undergone shunt related procedures like shunt removal, revision, reinsertion, exteriorization and external ventricular drain placement. In this study population, 122 cases had developed symptoms of shunt
infection and malfunction. Relevant data were collected from the patients as mentioned in the enclosed proforma. They include patients’ age and sex, aetiology of the hydrocephalus requiring ventriculoperitoneal shunt, date of shunt placement, number of prior revisions, history of prior shunt infections, results of culture
of CSF, shunt tube or pus and follow-up. CONCLUSION : Ventriculoperitoneal shunt infection is one of the major complications associated with mortality and morbidity resulting in neurological disturbances. The infection rate in patients with ventriculoperitoneal shunt was 10.58%. A large number of infections occurred in children with congenital malformations and following meningitis. Most of the infections occurred within 6 months of surgery. CSF gram staining and biochemical parameters were very useful n identification of shunt infection enabling empirical antibiotic therapy. Staphylococcus epidermidis was the commonest pathogen isolated. Pseudomonas aeruginosa was isolated in many patients with external drainage procedures suggesting nosocomial infection. Promising results are obtained by early removal of the shunt hardware accompanied by appropriate antibiotic therapy until CSF culture turns negative, followed by shunt replacement. With the emergence of methicillin resistant strains, ESBL and MBL producers, diligent use of antibiotics will restrict the spread of drug resistant strains in the community and environment
