Cerebrospinal fluid culture and analysis in paediatric patients with shunt infection

Background: Shunt insertion is an invasive procedure frequently done in patients with excess cerebrospinal fluid (CSF). It comes with the risk of infection which could be ascertained through CSF examination.

Objectives: To present the results of CSF culture and analysis in paediatric patients with shunt infection in Dr. Soetomo General Hospital, Surabaya, Indonesia.

Method: A retrospective study was conducted by reviewing medical records of patients with shunt infection aged 0–18 years old who were treated from January 2016 to December 2019.

Results: Seventeen cases of paediatric shunt infection were identified in this study. Six (35.3%) patients belonged to the 1–12 month age group. The aetiology of shunt insertion was hydrocephalus in all cases. Seizure was the most common chief complaint (23.5%) at presentation. During hospitalisation, recurrent fever was found in 7 (41.5%) cases. CSF analysis showed increased white blood cells in 12 (70.6%) cases, decreased glucose level in 11 (64.7%) cases and elevated protein level >100mg/dl in 12 (70.6%) cases. The most frequently isolated pathogens were Staphylococcus aureus and Staphylococcus epidermidis, each appearing in 4 (23.5%) cases, followed by Escherichia coli in 3 (17.7%) cases.

Conclusions: In this study paediatric patients with shunt infection showed raised white blood cells, decreased glucose and increased protein level on CSF examination. The most common pathogens were Staphylococcus aureus, Staphylococcus epidermidis, and Escherichia coli. Significant resistance to ampicillin was present.

Sri Lanka Journal of Child Health, 2021; 50(3): 436-441