Management of Pediatric CSF Shunt Infections

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Clinical presentation 

  • CSF leak, purulence, skin erosion,
  • Fever, meningismus, erythema,
  • exposed or protruding hardware

Lab investigations 

  • FBP, CRP
  • CSF analysis, C/S
  • Blood C/S

Pharmacological management 

Initiate empirical antibiotic treatment 

C: amoxicillin +clavulanate (FDC) (IV) 12hourly for 2weeks 

OR 

D: ceftriaxone+sulbactam (FDC) (IV) 100mg/kg 12hourly for 2weeks 

AND 

B: metronidazole (IV) 7.5mg/kg/day 8hourly for 2weeks 

Alternative regimen based on C/S results

S: piperacillin+tazobactam (FDC) (IV) 300mg/kg/day (of piperacillin component) divided in 4 doses per day 

OR 

S: meropenem (IV )10mg/kg 8 hourly, (may increase up to 40mg/kg) for 10-14days 

Shift to organism’s specific regimen after CSF/hardware culture results 
For confirmed Staph spp. infections add  

S: vancomycin (IV) 10mg/kg 6hourly for 2weeks or more. 

Non-pharmacological management 

  • Consider partial (externalization) or complete infected shunt hardware removal.
  • Insert  External  ventricular  drain  (EVD)  as  interim  measure  for  intracranial  pressure monitoring and therapeutic diversion of CSF in the setting where an infected internal shunt device has been removed.