Cerebrospinal Fluid Shunt Infections in a Pediatric Cohort: Clinical Predictors and Microbiological Insights from a Tertiary Center

Abstract

Aims:

This study aims to identify epidemiological, microbiological, and laboratory characteristics of cerebrospinal fluid (CSF) shunt infections in children and evaluate associated risk factors.

Patients and Methods:

Patients aged 0–18 years who underwent ventricular shunt placement at Gazi University Faculty of Medicine Hospital between January 1, 2010, and December 31, 2022, were retrospectively reviewed.

Results:

A total of 201 shunt procedures performed in 176 patients were analyzed, with infection occurring in 32 cases (15.9%). Infection rates were higher in subgaleal shunts (60%) than ventriculoperitoneal shunts (15.2%) (p = 0.018). Shunt infections developed in 31.7% of procedures involving at least one risk factor, compared with 5.7% of procedures without identified risk factors (p < 0.001). Preterm infants (<37 wks) had a higher infection rate (49%) than those born ≥37 weeks (14.5%) (p < 0.001). Gram-positive microorganisms accounted for 56.3% of infections, most commonly Staphylococcus sp., whereas Pseudomonas aeruginosa and Klebsiella species were the most frequent gram-negative pathogens (each 12.5%). Patients with gram-negative meningitis had a significantly higher intensive care unit admission rate than those with gram-positive meningitis (p = 0.021). In multivariate analysis, subgaleal shunt placement was associated with increased odds of shunt infection (OR: 12.13; CI: 1.36–107.69) (p = 0.025). In regression analysis, preterm birth was independently associated with an increased risk of shunt infection (OR: 6.12; CI: 2.02–18.56).

Conclusions:

Shunt infection rates and microbial patterns align with existing literature. Preterm birth emerged as a major risk factor for shunt infection, whereas subgaleal shunt placement appeared to be a potential risk factor that warrants cautious interpretation and further validation. The increased severity of gram-negative infections underscores the need for stringent monitoring and preventive strategies in high-risk populations.