(2012) showed that 35 out of 333 (10.5%) shunts became infected. The incidence of CSF shunt infections widely varies from 1% to 30%, and up to 35% of the infected shunts had Gram-negative bacteria as a pathogen. For MEDLINE and Google Scholar, we searched titles and abstracts containing the words CSF and VP shunt and Gram-negative bacterial infections. For PubMed, we searched for the articles and titles with Gram-negative bacteria, Gram-negative bacterial infections, CSF, and VP shunts. We conducted a systematic search of the PubMed, MEDLINE, and Google Scholar databases from 1972 to 2020. The purpose of this review article is to discuss the epidemiology, clinical features, management, and prevention of Gram-negative ventriculoperitoneal (VP) shunts in adults. Initial empirical intravenous antimicrobial therapy is preferably broad spectrum with appropriate coverage for resistant Gram-negative pathogens and the duration of treatment depends upon pathogenesis, host factors, and clinical response to the therapy.Ĭonsidering the importance of this disease and associated clinical outcomes, in this review article, we have summarized the epidemiology, clinical features, management, and prevention of Gram-negative VP shunt infections in adults.Ĭerebrospinal fluid (CSF) infections and ventriculitis caused by Gram-negative bacteria have worse outcomes. Apart from cerebrospinal fluid (CSF) analysis, microbiological cultures and radiological studies are key diagnostic tools. The clinical presentation of a ventriculoperitoneal (VP) shunt infection includes the signs and symptoms of meningitis to fever with abdominal pain and peritonitis. There are multiple risk factors for CNS infection after shunt insertion, including younger age, obstructive hydrocephalus, shunt revision surgery, and trauma. The most common bacteria include Escherichia Coli, Citrobacter species, Enterobacter species, Serratia species, and Pseudomonas aeruginosa. Cultures of bacteria help identify specific bacteria, but take days to complete.Gram-negative bacterial infections of the central nervous system (CNS) have worse clinical outcomes. The results help providers choose the first antibiotics to use. Gram stain can be done within a few hours. Examples of Gram-negative bacteria include Escherichia coli (E coli), Salmonella, Hemophilus influenzae, as well as many bacteria that cause urinary tract infections, pneumonia, or peritonitis. Examples of Gram-positive bacteria include Streptococcus and Staphylococcus aureus, as well as bacteria that cause anthrax, diphtheria, and toxic shock syndrome. When combined with the bacteria in a sample, the stain will either stay purple inside the bacteria (Gram-positive), or it will turn pink (Gram-negative). Bacteria are classified as either Gram-positive or Gram-negative, based on how they color in reaction with the Gram stain. A sample can also be taken from the site of a suspected infection, such as the throat, lungs, genitals, or skin. The tested sample can be taken from body fluids that do not normally contain bacteria, such as blood, urine, or cerebrospinal fluid. Gram stainĪ Gram stain is a test used to help identify bacteria. Cultures of bacteria help identify specific bacteria, but take days to complete. ![]() A Gram stain is a test used to help identify bacteria.
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