Ventriculoperitoneal Shunt Infection Research Articles

The Ventriculoperitoneal Shunt Complication Rate in Baghdad Medical City from 2019 to 2022

Background and aimsDue to the substantial lack of data from Iraq on ventriculoperitoneal shunt (VPS) complications, this study aims to examine the various types of complications after VPS surgery in Baghdad Medical City. MethodsThe retrospective cohort study analyzed VP shunt procedures at Baghdad Medical City from 2019 to 2022. The overall complication rate, including infection and shunt malfunction, was determined from patient records. Data were analyzed using descriptive statistics and Kaplan-Meier survival analysis. Ethical approval was obtained from the IRB, with consent waived due to the study's retrospective nature. The findings highlight the need for improved management to reduce complication rates in VP shunt procedures. ResultsThe study involved 113 participants with an average age of 2.62 years (±3.4). The most common indications for VPS placement are congenital hydrocephalus (40%) and post-infectious hydrocephalus (30%). The most common complications of post-VPS surgery are VP obstruction (54%) and post-surgical infections (44%). There were no significant differences in the incidence of post-operative complications across different age groups. ConclusionOur study showed the significant complication rate associated with VPS surgeries for hydrocephalus, particularly VPS infections and obstruction. There were no significant age-related differences in VPS complication rates across age groups.

Evaluation of ventriculoperitoneal shunt infections and risk factors in children.

To evaluate the demographic, clinical, diagnostic, and treatment data of pediatric patients with ventriculoperitoneal shunt infection and risk factors for ventriculoperitoneal shunt infection and recurrence of ventriculoperitoneal shunt infection. Patients aged 0-18 years who were diagnosed with ventriculoperitoneal shunt infection at CukurovaUniversity Faculty of Medicine Hospital between 2016 and 2021 were included in the study. Demographic, clinical, laboratory, and treatment data of the patients were evaluated retrospectively. Risk factors for the development and recurrence of ventriculoperitoneal shunt infection were evaluated. Patients who underwent ventriculoperitoneal shunt but did not develop any shunt infection were selected as the control group. Eighty-five patients with a diagnosis of ventriculoperitoneal shunt infection were included in the study. Fever (58.8%), anorexia (58.8%), vomiting (56.5%), and altered consciousness (54.1%) were the most common complaints at admission. The control group consisted of 48 patients. The number of shunt revisions was statistically significantly higher in the group that developed ventriculoperitoneal shunt infection compared to the control group (p < 0.001). In patients with ventriculoperitoneal shunt infection, C-reactive protein and cerebrospinal fluid protein values before shunt insertion were found to be statistically significantly higher than the control group (p < 0.001). Ventriculoperitoneal shunt infection occurs most frequently in the first months after shunt application. Therefore, it is extremely important to prevent colonization and contamination during surgery in preventing the development of ventriculoperitoneal shunt infection. In the present study, cerebrospinal fluid protein elevation and C-reactive protein elevation before shunt application were found to be significant in terms of the development and recurrence of ventriculoperitoneal shunt infection.

Investigating Ventriculoperitoneal Shunt Infections, Characteristics and Microbiology in Pediatric Patients with Hydrocephalus: A Single-Center Experience in Tehran, Iran

Background: This study investigates the epidemiology of ventriculoperitoneal (VP) shunt infections in pediatric patients with hydrocephalus, using data from 39 cases admitted to Loghman Hakim Hospital over a five-year period. Methods: This study was a case series involving a retrospective analysis of medical records, with a focus on demographic characteristics, etiological factors, and clinical outcomes. Statistical analyses were performed to explore associations between VP shunt infections and various variables. Results: The study identified a significant association between VP shunt infections and the presence of fever (P &lt; 0.05) as well as the number of white blood cells (WBCs) in cerebrospinal fluid (CSF) obtained from the VP shunt (P &lt; 0.01). This association may be explained by the release of cytokines during VP shunt infections, which can lead to the development of fever. Additionally, the stimulation of the immune system in response to the infection may cause an influx of WBCs into the CSF surrounding the VP shunt. Conclusions: This investigation offers valuable insights into the complex dynamics of VP shunt infections in pediatric patients with hydrocephalus. The observed associations between infection, fever, and WBC count enhance our understanding of the immunological responses triggered by VP shunt infections. These findings highlight the need for further research to elucidate these pathways, which could inform targeted interventions in the clinical management of VP shunt infections in pediatric populations.

Reducing the burden of repeated ventriculo-peritoneal shunt surgery and infection in low and middle income country.

Reducing the burden of repeated ventriculo-peritoneal shunt surgery and infection in low and middle income country.

The Landscape of Pediatric Hydrocephalus in the Province of KwaZulu-Natal: A Comparative Analysis of the Referral Pattern, Etiology, and Management Outcomes in 4 Distinct 5-Year Periods

BackgroundPaediatric hydrocephalus causes significant health burden globally, particularly in low and middle-income countries. There's a dearth of data from specific regions such as KwaZulu-Natal, South Africa. This study aimed to investigate the landscape of paediatric hydrocephalus, comparing four distinct five-year periods. MethodsData were collected retrospectively (2003 to 2007, 2008 to 2012, and 2013 to 2017) and prospectively (2018 to 2022). Children (≤18 years) treated for hydrocephalus were included. Data on demographics, referral patterns, aetiology, treatment modalities, and outcomes were collected and analyzed. ResultsA total of 3325 children were treated. The peak period was 2008 to 2012 (35.3%). Majority (51.4%) were from rural areas (p=0.013) and 47.9% were referred from regional hospitals, p=<0.001. Males (56.4%) and infants (60.2%) were predominant groups (p<0.001). Post-infectious aetiology (32.7%) was predominant (p<0.001), particularly tuberculous meningitis (54.1%). Ventriculoperitoneal shunts (VPSs) were the mainstay treatment (84.2%), with notable complication rates (20.4%), including infections (9.6%). HIV co-infection was diagnosed in 2.5% of cases. Weekend procedures were associated with VPS complications (HR1.3, CI:1.03-1.66, p=0.03). The mortality rate was 7.9%, and age ≥1 year (HR, 2.43 CI: 1.87-3.17, p<0.001), tertiary hospital referral (HR 1.48, CI: 1.06-2.04, p=0.019), VPS infection (HR, 3.63 CI: 2.66-4.95, p<0.001), acute abdomen (HR 2.17, CI: 1.11-4.25, p=0.024) and pneumonia (HR 7.32, OR 4.84 -11.06, p<0.001) were associated with mortality. ConclusionThis study provides comprehensive insights into pediatric hydrocephalus in KZN. Monitoring temporal trends and predictors of outcomes will aid guide future interventions aimed at mitigating the burden of pediatric hydrocephalus in the region.

LGG-19. SLIPPED CAPITAL FEMORAL EPIPHYSIS (SCFE): A RARE ADVERSE EVENT ASSOCIATED WITH FGFR TYROSINE KINASE INHIBITOR THERAPY IN A CHILD

Abstract BACKGROUND FGFR tyrosine kinase inhibitors (FGFR-TKIs) are being increasingly used off-label in children with hard-to-treat tumors harboring specific FGFR alterations. We report a case of Slipped Capital Femoral Epiphysis (SCFE), an on target skeletal toxicity of a pan-FGFR TKI inhibitor, erdafitinib. METHODS Data was extracted from chart review of the patient and literature search for the use of FGFR-TKIs in children and their side effects. RESULTS A 13-year-old boy was diagnosed to have a optic pathway/ hypothalamic glioma with signs of increased intracranial pressure and obstructive hydrocephalus requiring placement of ventriculo-peritoneal (VP) shunt. Sequencing of the tumor showed FGFR1-Tyrosine kinase domain internal tandem duplication (FGFR1-KD-ITD) and was negative for BRAF mutation/ fusion. Two weeks later, he was treated for a VP shunt infection (surgical revision and 6 weeks antibiotics). He developed hypothalamic obesity with rapid weight gain and BMI &amp;gt;30. After a four-month delay from the initial diagnosis, he was started on erdafitinib a pan-FGFR1-4 inhibitor, through a special access program. At 12 weeks of treatment, he developed persistent knee pain. X-ray of the hips showed slipped capital femoral epiphysis (SCFE) of the right hip. Erdafitinib was discontinued and he underwent surgery with in-situ pinning of the right hip and prophylactic pinning of the left hip. MRI at the time of stopping the medication showed a 30% decrease in the size of the tumor, which has remained stable at 6 months follow up. CONCLUSIONS Based on our experience and literature review of pediatric patients who are treated with pan-FGFR TKIs, we recommend: a) monitoring both rate of weight gain/ BMI for obesity and growth velocity while on therapy and b) update the drug toxicity profile of FGFR TKIs to include skeletal toxicities and inform parents/ patients of these toxicities at the time of consent for therapy.

Ventriculoperitoneal shunt infection and malfunction in adult patients: incidence, risk factors, and long-term follow-up of single institution experience.

Ventriculoperitoneal shunt surgery was developed to manage excessive cerebrospinal fluid (CSF) in the brain's ventricles and is considered a mainstream treatment. Despite the development of the shunt device system, various complications still occur. In this study, we reported 307 cases and a long-term follow-up of at least five years of adult patients who underwent VP shunt surgery and analyzed various factors that may affect revision surgery. A retrospective study was conducted at Asan Medical Center, Korea, a tertiary medical center. We reviewed 307 cases from January 2012 to December 2018. The patients' neurological status, predisposing medical conditions, laboratory findings, and other operation-related factors were reviewed using electrical medical records. The normal function group comprised 272 cases (88.6%), and the overall incidence of revision group comprised 35 cases (11.4%). Of the 35 revision surgery cases, 30 (85.71%) were due to shunt malfunctions, such as obstruction, overdrainage, and valve-related errors while 5 (14.29%) were due to shunt infection. Patient demographics, mental status, and operation time did not influence revision as risk factors. Serum laboratory findings showed no statistical difference between the two groups. The white blood cell (WBC) count in the CSF profile differed significantly between the two groups. The Hakim Programmable valve (Codman, USA) is mainly used in our center. In addition, various shunt systems were used, including Strata Regulatory valve (Medtronic, USA), proGAV (Aesculap, USA), and Accu-Flo (Codman, USA). This study analyzed the factors affecting long-term outcomes. Based on these findings, efforts are needed to achieve more favorable outcomes in the future.

Effect of cranial entry site on the rate of proximal catheter misplacement in ventriculoperitoneal shunt insertion.

The insertion of a ventriculoperitoneal shunt (VPS) is a common neurosurgical procedure, but the optimal entry site of the ventricular catheter is still under debate. In this study, the authors compare the parietal (Keen's) and frontal (Kocher's) entry sites in terms of the rate of revision surgery due to ventricular catheter misplacement, VPS dysfunction, and VPS infection. The authors retrospectively analyzed the data on consecutive adults (age ≥ 18 years) who had undergone primary VPS insertion between 2010 and 2020 at two neurosurgical centers. One center regularly inserts the ventricular catheter frontally (frontal group); the other center, parietally (parietal group). The primary outcome of interest was the rate of ventricular catheter misplacement necessitating revision surgery. Secondary outcomes were functional outcome as measured by the modified Rankin Scale (mRS), rate of revision surgery for VPS dysfunction and infection, as well as early (≤ 30 days) and late (> 30 days) mortality rates. Propensity score matching was performed based on baseline variables, such as normal pressure hydrocephalus, postinfectious hydrocephalus, and idiopathic intracranial hypertension, which were identified as predictors of ventricular catheter misplacement using logistic regression analysis. Among 539 consecutive patients, 301 (55.8%) were in the frontal group and 238 (44.2%) in the parietal group. Postoperative rates of revision surgery due to misplacement were comparable in the two catheter entry site groups (frontal 14 [4.7%] vs parietal 11 [4.6%], p = 0.987). Rates of revision surgery for VPS dysfunction (14 [4.7%] vs 10 [4.2%], respectively, p = 0.802) and infection (22 [7.3%] vs 10 [4.2%], p = 0.13) exhibited no significant differences. Favorable functional outcomes (mRS score ≤ 2; 164 [76.3%] vs 174 [79.5%], respectively, p = 0.058) and early mortality rates (5 [1.7%] vs 6 [2.5%], p = 0.483) were similar between the groups. After propensity score matching, the primary and secondary outcome measures remained comparable between the groups. The entry site of the ventricular catheter in VPS surgery does not seem to affect proximal revision rates. Further, revision rates due to VPS dysfunction, VPS infection, and morbidity were comparable as well.

Implementation of an adapted perioperative ventriculoperitoneal shunting protocol in a tertiary center located in a low-to-middle-income country.

Preventative protocols have efficaciously reduced shunt infection in developed countries. However, the generalizability of these protocols in low-to-middle-income countries (LMICs) remains unclear. Previously, shunt insertion in the authors' center was routinely performed under institutional preventative precautions, which was updated via merging with the Hydrocephalus Clinical Research Network (HCRN) protocol. This study aimed to investigate the ventriculoperitoneal shunt (VPS) infection rates in pediatric patients following the implementation of the adapted protocol. The adapted protocol was implemented in all first-time VPS implantations between 2011 and 2021. The primary outcome was a 6-month shunt infection. The Pearson chi-square test was used for categorical variables and the Mann-Whitney U-test for numeric variables to evaluate the correlation with shunt infection. A total of 352 first-time VPS procedures were performed adhering to the adapted protocol. The median age was 5months, and 189 (53.7%) were male. Overall, 37 patients (10.5%) experienced shunt infection, with 30 (8.5%) occurring within the first 6months, which was lower than 13.3% infection rate of the previous series of the same center. The infection rate was slightly higher than the 5.7% and 6.0% rates reported by HCRN studies. Patients with shunt infection were significantly younger (7.5 versus 17.5months, P < 0.001). This study validates the efficacy of an adapted perioperative protocol in mitigating shunt infection in a high-volume center in a LMIC. Adhering to a step-by-step protocol, modified to suit the healthcare resources and financial constraints of LMICs, could maintain low shunt infection rates that are roughly comparable to those of centers in high-income countries.

Measurement of cerebrospinal fluid lactate levels in pediatric patients with suspected ventriculoperitoneal shunt infection: A retrospective cohort study

IntroductionVentriculoperitoneal shunt (VPS) infection is a severe complication. Early diagnosis could help to decrease morbidity and treatment costs. Lactate has been used for the diagnosis of other central nervous system infections. The aim of this study is to determine the usefulness of lactate for the diagnosis of VPS infection. MethodologyRetrospective cohort study. Lactate was measured in patients who consulted with VPS dysfunction between May 2019 and May 2022. Mean were compared according to culture results. A Receiver Operating Characteristic (ROC) curve was performed to determine the appropriate cut-off point. ResultLactate has a high negative predictive value but a low positive predictive value for the diagnosis of ventriculitis.

Ventriculoperitoneal shunt infection rate and other associated complications of VP shunt insertion in Abuja, Nigeria

BackgroundComplications associated with ventriculoperitoneal shunt insertion constitute a significant cause of morbidity and mortality among hydrocephalus patients. Despite this, VP shunt placement has remained the mainstay of treatment for hydrocephalus. The aim of this study is to evaluate the complications of VP shunt surgery in our environment and to identify the risk factors associated with it. MethodologyPatients who had VP shunt surgery over a period of two years (Jan 2015–December 2016) were evaluated retrospectively by reviewing their hospital records. The patients’ demography, aetiology and clinical presentation of the hydrocephalus, and complications were analysed using SPSS version 26.0. Results were presented in tables and figures. ResultsA total of 69 patients who had VP shunt over the study period had complete medical records available for review. Their age ranged between 2days and 68years with a male to female ratio of 1.8:1. Overall complication rate was 30.4%. Shunt malfunction (11.5%) and shunt infection (7.2%) were the commonest complications recorded. Late presentation was the most important risk factor for shunt complications. ConclusionThe rate of shunt complications seen in this study compares fairly with studies in other parts of the world.

Comparative analysis of linezolid, vancomycin, and hyperbaric oxygen therapies in a rat model of ventriculoperitoneal shunt infection.

Staphylococcus epidermidis is the most common causative microorganism of ventriculoperitoneal shunt infections. This study aimed to compare linezolid and vancomycin treatments and to examine the effect of these antibiotics alone and combined with hyperbaric oxygen therapy on the amount of bacterial colonies in the experimental S. epidermidis shunt infection model. A shunt catheter was placed in the cisterna magna of 49 adult male Wistar albino rats. The rats were randomly divided into seven groups, as follows: sterile control, infected control, vancomycin, linezolid, hyperbaric oxygen, vancomycin + hyperbaric oxygen, linezolid + hyperbaric oxygen. In all groups except the sterile control group, 0.2ml 107CFU/mL S. epidermidis was inoculated to the cisterna magna. Parenteral vancomycin was administered 40mg/kg/day to the vancomycin groups, and 50mg/kg/day of enteral linezolid to the linezolid groups. Hyperbaric oxygen groups were given 100% oxygen at a pressure of 2.4 ATA for 50min a day. One day after the last treatment, colony quantities in the shunt catheters and CSF were analyzed. The number of CSF colonies in the linezolid group was significantly lower than in the vancomycin group (p < 0.05). The number of CSF colonies in the linezolid + HBO group was significantly lower than in the vancomycin + HBO group (p < 0.05). Linezolid treatment was found to be more effective than vancomycin in ventriculoperitoneal shunt infection caused by S. epidermidis. There was no statistical difference among other treatment groups. Hyperbaric oxygen therapy is shown to contribute to the sterilization of cultures.

Systemic immuno-inflammation index as a prognostic factor in ventriculoperitoneal shunt infection

Systemic immuno-inflammation index as a prognostic factor in ventriculoperitoneal shunt infection

Peripheral white blood cell patterns in children with hydrocephalus as a response to ventriculo-peritoneal shunt infection.

Shunt infection is one of the most common complications of conventional hydrocephalus treatment. The route of invasion of a pathogen can modify the immune response of the CNS. The aim of the study is to analyze the immune response to shunt infection caused by S. epidermidis in children with hydrocephalus. The immune response to the pathogen will be analyzed on the basis of, inter alia, simple laboratory test results, such as changes in the pattern of white blood cells, including neutrophils, monocytes, and lymphocytes. The entire study analyzes changes in general parameters of the cerebrospinal fluid (pleocytosis, protein level, glucose level) and in levels of selected interleukins (IL-6, CXCL8 / IL-8, CCL3 / MIP-1a) in the cerebrospinal fluid. The clinical material analyzed in the study was collected in 2010-2014. The study group consisted of 30 patients, who were admitted to the hospital due to their first-ever episode of valve dysfunction caused by S. epidermidis infection. The control group consisted of 30 children who also suffered from congenital hydrocephalus but had not been operated on before. The most pronounced response to CSF infection in the study group was a significant increase in the counts of all investigated WBC lines in the samples collected immediately after the patients' admission to the ward. The earliest aberration of the CSF was a significant increase in protein level. An infection of a ventriculoperitoneal shunt caused by S. epidermidis evokes a very early peripheral blood response. In children affected by a ventriculoperitoneal valve infection, the humoral immune response detected in the cerebrospinal fluid precedes the increase in the level of pleocytosis. The highest level of cytokines in the cerebrospinal fluid is achieved when the pathogens are cleared. Phagocytes, and, in particular, monocytes, play an important role in the normalization of the cerebrospinal fluid parameters after the elimination of S. epidermidis. The local immune response of the central nervous system plays an important role in extinguishment of the inflammatory process.

TITLE: Evaluation of ventriculoperitoneal shunt infection incidence and preoperative antibiotic prophylaxis in children Running title: Evaluation of ventriculoperitoneal shunt infection

TITLE: Evaluation of ventriculoperitoneal shunt infection incidence and preoperative antibiotic prophylaxis in children Running title: Evaluation of ventriculoperitoneal shunt infection

The incidence of VP shunt infection in a middle-income nation: a retrospective analysis of a pediatric population.

To investigate the incidence of infection after ventriculoperitoneal shunt (VPS) insertion at the Bustamante Hospital for Children (BHC), Jamaica, West Indies. Of the 178 patients managed by the Neurosurgery team at BHC, who underwent surgery between 2010 and 2016, 122 patients were subjected to the cerebrospinal fluid (CSF) diversion procedure through a VPS placement. The patients excluded from this study included those with a VPS placed at another institution or one placed prior to the study period. There is a notable transition that saw a switch from the use of the Codman uni-port to Medtronic shunts in 2014-2015, which initiated the process of reuse of shunt passers. Clinical data were retrospectively collected from operating theater logs and available manual health records. Over the 7-year study period of the 122 first-time shunt placements done, 17 patients (13.9%) had positive CSF cultures, with an additional six (4%) having CSF pleocytosis with negative cultures. The most common isolate was the Staphylococcus species, occurring in 60% of VPS infections. The median time to shunt infection was 2 months. Of the 72 Codman shunts placed, six became infected, and 21.7% (10 of 46) of the Medtronic shunts became infected. The rate of incidence of VPS infection was 13.9% for the period between 2010 and 2016, with most infections occurring after 2014. The major causative agent was Staphylococcus species at 60% within a median 2 months of surgery. Overall, this compares well with data reported in the literature.

Incidence of Ventriculoperitoneal (VP) Shunt Infection In Vancomycin-Drenched VP Shunts

Objective: To determine the occurrence of infection in patients with VP (Ventriculoperitoneal) shunts that were drenched in vancomycin. Materials and Methods: A descriptive case series study was done in The Department of Neurosurgery, Lady Reading Hospital, Peshawar, Pakistan from 10 September 2019 to 31 December 2020 to ascertain the frequency of VP shunt infections in vancomycin-drenched VP shunts. The patients were followed for 06 months. Results: A total of 100 patients were included in this study. There were 44 (44%) men and 56 (56%) women. Age ranged from birth to 18 years. Patients younger than 1 year were 44 (44%), older than 1 to 10 years were 33 (33%) and older than 10 years were 23 (23%). Congenital hydrocephalus was the most common type observed in 49 (49%) patients. Shunt infection occurred in 7 patients (7%) within 6 months after surgery. Staphylococcus aureus was the most common pathogen identified in 05 of 07 (71%) infected patients. P value &lt;0.05 was observed in Vancomycin-soaked VP shunts and shunt infection, which is significant. Conclusion: The rate of shunt infection was significantly reduced when 2 mg/mL topical vancomycin was used intraoperatively (intra- and peri-shunt) in conjunction with a multi-step shunt infection prevention program. This treatment may be less expensive than using an antibiotic-impregnated catheter (AIC).

1319. Microbiology and Epidemiology of Pediatric Ventriculoperitoneal Shunt Infections

Abstract Background Infections complicate approximately 10% of ventriculoperitoneal (VP) shunts in children, with considerable associated morbidity and mortality. Recent guidelines for empiric treatment of VP shunt infections recommend use of vancomycin combined with an anti-pseudomonal beta-lactam, but are based on low-quality evidence. We aimed to further characterize and update the microbiology of pediatric VP shunt infections using the U.S. Military Health System database. Methods Department of Defense beneficiaries less than 22 years-of-age admitted for VP shunt infection between Oct 1, 2008 and Sep 30, 2019 were included. VP shunt infection was defined using a combination of ICD-9-CM and ICD-10-CM codes, CPT codes for removal or replacement of a shunt (Table 1), and positive cultures from a normally sterile site (cerebrospinal fluid, blood, catheter tip, and peritoneum). Demographic data on age, sex, and year of admission were collected for each patient, as was microbiologic data including organism and specimen source. Results There were 32 qualifying admissions among 30 patients for VP shunt infection over the 10-year study period, with no discernable year-to-year trend identified. Half of all VP shunt infections occurred in patients less than 12 months of age (Table 2). Sixty-one unique positive cultures were identified among the 30 patients, 38 (62%) from CSF samples, and the remaining 23 (38%) from blood, peritoneum, and catheter tips (Figure 1). Coagulase-negative Staphylococcus (28%), Staphylococcus aureus (15%), and Enterococcus spp. (10%) were the leading causative pathogens (Figure 2). Enteric gram-negative rods accounted for 21% of positive cultures. Pseudomonas spp. were rarely isolated (3%), however, strict anaerobic pathogens made up 8% of positive cultures. Conclusion Empiric antibiotic treatment of VP shunt infections in children should cover gram-positive cocci and enteric gram-negative rods but need not cover Pseudomonas spp. Existing guidelines do not recommend anaerobic coverage, however, these data indicate empiric anaerobic coverage is prudent, especially when an intra-abdominal VP shunt infection is suspected. Disclosures All Authors: No reported disclosures

The Prognostic Nutritional Index and Mortality in Patients With Ventriculoperitoneal Shunt Infection.

The objective of this study was to investigate the relationship between mortality and the prognostic nutritional index (PNI) in the pediatric patient group with ventriculoperitoneal shunt (VPS) infection. A total of 63 pediatric patients with a VPS infection and positive cerebrospinal fluid (CSF) culture were retrospectively registered. The CSF specimens were analyzed to conduct culture and microscopic evaluation. A total of 44.4% of the cases were men and 55.6% of the cases were women. Patients were divided into 2 groups (survivor and non-survivor patients). When survivor and non-survivor patients were compared, it was found that CSF leukocytes, CSF glucose, CSF protein, CSF/blood glucose ratio, lymphocyte, albumin, and PNI levels were lower in the non-survivor patients' group. Nevertheless, blood glucose and CRP (C-reactive protein) were significantly higher in the non-survivor patients' group than in the survivor patients' group. In our investigation, we suggested that low PNI was related to high mortality in cases of VPS infection.

Relationship between catheter related cerebrospinal fluid infections and systemic immune-inflammation index.

This study investigated the relationship between the systemic immune inflammation index (SII) and catheter-related infections and their effects on prognosis in pediatric patients. A total of 56 pediatric patients diagnosed with ventriculoperitoneal (V-P) shunt infection between January 2017 and October 2019 were included. V-P shunt infection diagnosis was made based on clinical findings. All cerebrospinal fluid (CSF) samples were subjected to direct microscopic examination and culture. Protein, glucose, and sodium levels in CSF, CSF leukocytes, and hematological and biochemical parameters were measured. Fifty-six patients with growth in CSF culture were included in this study. 55.4% of the cases were female and 44.6% male. V-P shunt was detected in 82.1% of the cases and external ventricular drainage (EVD) catheter-related infection in 17.9%. The CSF/blood glucose ratio was significantly lower (p=0.046), and SII was significantly increased (p=0.002) in non-coagulase-negative staphylococci. Early and appropriate antibiotic therapy reduces morbidity and mortality in catheter-related infections. However, it is important to start empirical antibiotherapy until culture results are expected. Therefore, further research on the estimation of possible factors is needed.