Characteristics and outcomes of cerebrospinal fluid shunt and drain-associated infections

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Data on infections associated with cerebrospinal fluid shunt (CSF-S) or device-associated infection (CSF-SDI) are limited in adults. We performed a retrospective study to describe characteristics, management, and outcome of CSF-SDI. All patients with CSF-SDI and admitted to our institution from January 2013 to December 2019 were included. Among 50 patients, fifty-six episodes of CSF-SDI (41 external ventricular device-associated infections (CSF-D) and 15 other shunt infections (CSF-S) were included. The incidence of CSF-SDI was 11.9%. Fever was the most common symptom (81%). Enterobacterales were more prevalent in CSF-S than in CSF-D (20% vs 53%, p=0.02). As regards CSF-D, deceased patients (11/41, 27%) more frequently had a Glasgow coma scale score decreasing from baseline (p<0.01), lower glycorrhachia (p<0.01), a higher protein level in CSF (p=0.001) and a positive control CSF culture (p=0.031). CSF-SDIs are rare but with a high mortality rate. Mortality was more closely related to the infection than to comorbidities or underlying neurosurgical disease. A second CSF analysis significantly helped to detect patients with CSF-D with a poor prognosis.