BACKGROUND:
CSF shunts significantly improve the quality of life for patients with Hydrocephalus. Infection associated with a CSF shunt are difficult to treat especially in a limited resource country. Data on infection associated with CSF shunts among children are associated with high morbidity and substantial mortality.
METHODS:
The present study is a prospective analysis of sixty hydrocephalic children who had undergone shunt surgeries due to multifactorial etiology, their risk factors, antibiotic sensitivity pattern and outcome following surgery for a period of fifteen months.
RESULTS:
Ten patients out of sixty patients were culture positive, and infection rate was 16.6% with infection load increased in age group less than one year (48%). This study has documented 92% risk of infection within 90 days of surgery. Fever (38%), vomiting (17%), increase in head circumference (15%), altered sensorium and seizures (10%), visual disturbances (5%) were indications of rise in intracranial tension in paediatric age group. The statistically significant risk factors are Obstructive Hydrocephalus and Preterm with Intraventricular Haemorrhage where survival rate increased in former and decreased in latter.
The most prevalent organisms were Coagulase Negative Staphylococci (50%), Staphylococcus aureus (10%) and Gram Negative Bacteria (40%). Gram Positive Bacteria was 100% sensitive to Vancomycin quantitative E strip method. MBL producing strain of Acinetobacter (10%) in this study was 100% sensitive to Colistin, Tigecycline, Levofloxacin and Netilimycin.
CONCLUSION:
Low virulent organisms have subclinical course and high index of suspicion with implementation of quantitative documentation of drug susceptibility pattern in routine will prevent the alarming rise of resistance pattern. Operational Theatre surveillance, Infection Control Committee and standardisation of protocol in collaboration with Microbiology department to adhere stringent stewardship must be implemented in routine tertiary care units to prevent infections in these live saving operations in Neurosurgery
