EP213 - CONSERVATIVE MANAGEMENT OF CEREBROSPINAL FLUID SHUNT INFECTIONS IN SELECTED PEDIATRIC PATIENTS (ID 965)
Abstract
Title of Case:
CONSERVATIVE MANAGEMENT OF CEREBROSPINAL FLUID SHUNT INFECTIONS IN SELECTED PEDIATRIC PATIENTS
Background:
Treatment of cerebrospinal fluid (CSF) shunt infections is challenging due to the biofilm formation. Shunt replacement is often considered the most effective approach which, however, implies prolonged hospitalization, repeated surgery and possibly other complications. A conservative management using high doses of antibiotics with good penetration in the central nervous system for prolonged period of time could, alternatively, be discussed for selected patients.
Case Presentation Summary:
We present 4 patients with ventriculoperitoneal (VP) shunt infection treated with antibiotics only over the last 3 years. i) A 4-month old infant with shunt infection (Staphylococcus epidermidis) received linezolid and ciprofloxacin intravenously (10 days) followed by oral rifampicin (20 mg/kg/d) and cotrimoxazole (16 mg/kg/d) (3 months); ii) a 2-year old girl (cultures negative) received daptomycin (10 mg/kg/d) (7 days) followed by oral cotrimoxazole (15 mg/kg/d) (2 months); iii) a 11.5-year old girl (Staphylococcus aureus) received linezolid (10 days) followed by oral ciprofloxacin (500 mg bid) and rifampicin (300 mg bid) (2 months); iv) a 5.5-month old preterm infant with a history of VP shunt replacement at 4 months of age, developed again VP shunt infection (cultures negative) and received intravenously meropenem, colistin and vancomycin (2 weeks) followed by oral cotrimoxazole (15 mg/kg/d) and rifampicin (20 mg/kg/d) for 9 months. Treatment was prolonged, as there was a slow but consistent normalization of glucose and protein in repeated CSF samples. All patients were regularly monitored for blood, renal and hepatic toxicity. No recurrence of shunt infection was observed for any of these patients.
Learning Points/Discussion:
In selected patients with VP shunt infection treatment can be achieved with high dose, prolonged antimicrobial therapy. The optimization of this approach warrants further study.
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