Schreffler and colleagues performed a detailed decision analysis of the treatments options for CSF shunt infection based on available data since the introduction of these devices (135). The cure, failure, and death rates for three different strategies are summarized in the table below (68, 84, 170).
Results of Treatment Options in the Management of CSF Shunt Infections
|Shunt removal with immediate shunt replacement and IV antibiotics, with or without shunt antibiotics||64.4%||24.4%||11.1%|
|Shunt removal, EVD and IV antibiotics, with or without intraventricular antibiotics||87.7%||6.6%||5.7%|
Adapted from Schreffler RT et al.: Treatment of cerebrospinal fluid shunt infections: a decision analysis (135).
Aside from CSF shunt hardware removal, the mainstay of infection control and treatment relies on antibiotic therapy. However, several pitfalls affect the decision to treat these clinical situations, as false positive cultures for skin contamination during a shunt tap can mislead treatment and partially treated infections can give negative cultures (e.g.., patients who had fever and headache and were treated for suspected upper respiratory tract infections but have evidence of a potential shunt malfunction).
The intraventricular use of antibiotics has been reported in the past for the treatment of infections that have not responded well to systemic therapy or in addition to standard systemic IV therapy (66, 85, 124).