CSF shunt infection in children:: prevention and treatment.

Cerebrospinal fluid (CSF) shunting has developed into the mean method of treatment in children with hydrocephalus. Until the last decade, shunt infection was the most important cause of morbidity with a mean rate of 10%. Most of shunt infection (>90%) are diagnosed within six months after surgery supporting a basic premise of direct contamination at the time of surgery. However, after applying stricter operative and perioperative protocols, some authors reported a dramatically decrease in the incidence of infectious complications. The overall annual risk of shunt infection in a paediatric neurosurgical unit is currently 1%. Risk factors are analysed with emphasis on the choice of preventive treatment. An outline of the protocol for shunt implantation is presented. There is no clearly defined role for prophylactic antibiotic medications in the prevention of shunt infection. The small sample sizes of prospective controlled clinical trials precluded sufficient statistical power. The conclusions of the meta-analyses are not sufficiently robust to resolve the controverse and it is not possible to make recommendations either for or against the use of prophylaxis in shunt surgery. The management of shunt infection is examined with emphasis on antibiotic therapy. (C) 2002 Editions scientifiques et medicales Elsevier SAS.