Suspected Neurosurgical Shunt Infection Clinical Pathway

Pathway Background and Objectives

Ventricular-peritoneal shunt placement is a common neurosurgical procedure. Ventricular-peritoneal shunt infection is a known risk in children with this hardware. Early recognition and treatment is essential to prevent further morbidity, and it also leads to decreased medical costs. The goals of the pathway are early recognition of and delivery of appropriate care for suspected shunt infection. The specific objectives are to:

Decrease unnecessary antibiotic usage
Ensure appropriate lab tests are ordered for suspected shunt infection
Ensure appropriate antibiotic initiation in the emergency department
Ensure timely surgical interventions
Ensure appropriate adjustment of antibiotics post operatively in consultation with Infectious Disease physicians

Algorithm Educational Module

Key References

Simon TD, Hall M, Riva-Cambrin J, Albert JE, Jeffries HE, LaFleur B, Dean MJ, Kestle JRW, and in collaboration with the Hydrocephalus Clinical Research Network. Infection rates following initial cerebrospinal fluid shunt placement across pediatric hospitals in the United States. J Neurosurg Pediatr. 2009 Aug;4(2):156 -65.
Simon TD, Hall M, Dean JM, Kestle JR, Riva-Cambrin J. Reinfection following initial cerebrospinal fluid shunt infection. J Neurosurg Pediatr. 2010 Sept;6(3):277-85.
Duhaime AC. Evaluation and management of shunt infections in children with hydrocephalus. Clin Pediat. 2006 Oct; 45(8):705-13.
Sarmey N, Kshettry VR, Shiver MF, Habboub G, Machado AG, Well RJ. Evidence-based interventions to reduce shunt infections: a systematic review. Childs Nerv Syst. 2015 Apr;31(4):541-49.
Kestle JR, Riva-Cambrin J, Wellons JC 3rd, Kulkarni AV, Whitehead WE, Walker ML, Oakes WJ, Drake JM, Luerssen TG, Simon TD, Holubkov R, and in collaboration with the Hydrocephalus Clinical Research Network. A standardized protocol to reduce cerebrospinal fluid shunt infection: The Hydrocephalus Clinical Research Network Quality Improvement Initiative. J Neurosurg Pediatr. 2011 Jul;8(1):22-9.

Disclaimer

The clinical pathways in the above links have been developed specifically for use at Connecticut Children’s and are made available publicly for informational and/or educational purposes only. The clinical pathways are not intended to be, nor are they, a substitute for individualized professional medical judgment, advice, diagnosis, or treatment. Although Connecticut Children’s makes all efforts to ensure the accuracy of the posted content, Connecticut Children’s makes no warranty of any kind as to the accuracy or completeness of the information or its fitness for use at any particular facility or in any individual case.