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Cerebrospinal Fluid Shunt Infections: A Multicenter Pediatric Study
The Pediatric Infectious Disease Journal (2022)
  • Alistair McAlpine, Univ of British C
  • Joan Robinson
  • Michelle Barton, Western University

Infections complicate 5%–10% of cerebrospinal fluid (CSF) shunts. We aimed to describe the characteristics and contemporary pathogens of shunt infections in children in Canada and the United States.


Descriptive case series at tertiary care hospitals in Canada (N = 8) and the United States (N = 3) of children up to 18 years of age with CSF shunt infections from July 1, 2013, through June 30, 2019.


There were 154 children (43% female, median age 2.7 years, 50% premature) with ≥1 CSF shunt infections. Median time between shunt placement and infection was 54 days (interquartile range, 24 days–2.3 years). Common pathogens were coagulase-negative staphylococci (N = 42; 28%), methicillin-susceptible Staphylococcus aureus (N = 24; 16%), methicillin-resistant S. aureus (N = 9; 5.9%), Pseudomonas aeruginosa (N = 9; 5.9%) and other Gram-negative bacilli (N = 14; 9.0%). Significant differences between pathogens were observed, including timing of infection (P = 0.023) and CSF leukocyte count (P = 0.0019); however, differences were not sufficient to reliably predict the causative organism based on the timing of infection or discriminate P. aeruginosa from other pathogens based on clinical features. Empiric antibiotic regimens, which included vancomycin (71%), cefotaxime or ceftriaxone (29%) and antipseudomonal beta-lactams (33%), were discordant with the pathogen isolated in five cases. There was variability between sites in the distribution of pathogens and choice of empiric antibiotics. Nine children died; 4 (44%) deaths were attributed to shunt infection.


Staphylococci remain the most common cause of CSF shunt infections, although antibiotic resistant Gram-negative bacilli occur and cannot be reliably predicted based on clinical characteristics.
  • csf,
  • shunt infections,
  • children
Publication Date
Summer June 1, 2022
10.1097/INF.0000000000003513. Epub 2022 May 6
Publisher Statement
Citation Information
McAlpine A, Robinson JL, Barton Michelle, Balamoran A, Davies H Dele, Skar G, Lefebvre Marie-Astrid, Almadani A, Freire Dolores, Le Saux Nicole, Bowes Jennifer, Srigley Jocelyn, Passarelli Patrick, Bradley John, Khan Sarah, Purewal Rupeena, Viel-Theriault, Ranger A, Hawkes MT. Cerebrospinal fluid shunt infections: a multicentre pediatric study.. PIDJ 2022 Jun 1;41(6):449-454; doi: 10.1097/INF.0000000000003513. Epub 2022 May 6.