Infecções de derivações liquóricas em crianças: revisão de 100 infecções em 87 crianças

Martins, Roberto; Ciquini Jr., Orildo; Matushita, Hamilton; Cabral, Nilton Domingos; Plese, José Píndaro Pereira

doi:10.1590/S0004-282X1997000100012

Resumos

Estudo retrospectivo analisando quadro clínico e resultados terapêuticos de 100 episódios de infecções em 87 crianças submetidas a derivações liquóricas no período de 1982 a 1995.O quadro clínico mais frequente foi aquele secundário ao processo inflamatório e os agentes etiológicos mais comuns foram os estafilococos. A infecção ocasionada por agente Gram negativo mostrou maior gravidade e esteve mais frequentemente relacionada a falha terapêutica. As estratégias de tratamento incluíram desde o uso de antibióticos sistêmicos de forma isolada até a retirada do sistema de derivação e a utilização de antibióticos sistêmicos e intratecais. Os melhores resultados terapêuticos foram obtidos com: retirada da derivação e sua substituição por derivação ventricular externa associada a antibióticoterapia sistêmica. Em nossa experiência, essa conduta deve ser adotada como rotina para o tratamento desta grave complicação.

hidrocefalia; infecção; derivação; líquido cefalorraqueano

An analysis of 100 infections in 87 children treated with shunts in the period of 1982 to 1995 is reported. The clinical presentation has been more frequently secondary to inflamatory signals. Staphylococcus were the most frequently microrganisms found. Infection by Gram negative agents was more aggressive and directly related with failure of therapy. Treatment included since only systemic antibiotics until withdrawal of shunt with use of systemic and intrathecal antibiotics. The best therapeutic results were obtained with withdrawal of shunt system and replacement by external shunt system associated to systemic antibiotics. In our experience this management must be accepted for treatment of this severe complication.

hydrocephalus; shunt; infection; cerebrospinal fluid

Infecções de derivações liquóricas em crianças: revisão de 100 infecções em 87 crianças

Infections of cerebrospinal fluid shunts in children: revision of 100 infections in 87 children

Roberto Martins^I; Orildo Ciquini Jr.^II; Hamilton Matushita^II; Nilton Domingos Cabral^II; José Píndaro Pereira Plese^III

^IMédico Residente. Disciplina de Neurocirurgia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP)

^IIMédico Assistente. Disciplina de Neurocirurgia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP)

^IIIProfessor Associado. Disciplina de Neurocirurgia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP)

RESUMO

Estudo retrospectivo analisando quadro clínico e resultados terapêuticos de 100 episódios de infecções em 87 crianças submetidas a derivações liquóricas no período de 1982 a 1995.O quadro clínico mais frequente foi aquele secundário ao processo inflamatório e os agentes etiológicos mais comuns foram os estafilococos. A infecção ocasionada por agente Gram negativo mostrou maior gravidade e esteve mais frequentemente relacionada a falha terapêutica. As estratégias de tratamento incluíram desde o uso de antibióticos sistêmicos de forma isolada até a retirada do sistema de derivação e a utilização de antibióticos sistêmicos e intratecais. Os melhores resultados terapêuticos foram obtidos com: retirada da derivação e sua substituição por derivação ventricular externa associada a antibióticoterapia sistêmica. Em nossa experiência, essa conduta deve ser adotada como rotina para o tratamento desta grave complicação.

Palavras-chave: hidrocefalia, infecção, derivação, líquido cefalorraqueano.

ABSTRACT

An analysis of 100 infections in 87 children treated with shunts in the period of 1982 to 1995 is reported. The clinical presentation has been more frequently secondary to inflamatory signals. Staphylococcus were the most frequently microrganisms found. Infection by Gram negative agents was more aggressive and directly related with failure of therapy. Treatment included since only systemic antibiotics until withdrawal of shunt with use of systemic and intrathecal antibiotics. The best therapeutic results were obtained with withdrawal of shunt system and replacement by external shunt system associated to systemic antibiotics. In our experience this management must be accepted for treatment of this severe complication.

Key words: hydrocephalus, shunt, infection, cerebrospinal fluid.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Dr. Roberto Martins - Clínica Neurológica, Hospital das Clínicas, FMUSP - Avenida Enéas Carvalho de Aguiar 255,5º andar - 05403-000 São Paulo SP - Brasil.

1. Choux M, Genitori L, Lang D, Lena G. Shunt implantation: reducing the incidence of shunt infection. J Neurosurg 1992;77:875-880.
2. Finney HL, Roberts TS. Nephritis secondary to chronic cerebrospinal fluid-vascular shunt infection: "shunt nephritis". Child's Brain 1980;6:189-193.
3. Forward KR, Fewer HD, Stiver HG. Cerebrospinal fluid shunt infections: a review of 35 infections in 32 patients. J Neurosurg 1983;59:389-394.
4. Frame PT, McLaurin RL. Treatment of CSF shunt infections with intrashunt plus oral antibiotic therapy. J Neurosurg 1984;60:354-360.
5. Gardner P, Leipzig T, Phillips P. Infections of the central nervous system shunts. Symposium on infections of the central nervous system. Med Clin North Am 1985;69:297-314.
6. Garvey G. Current concepts of bacterial infections of the central nervous system-bacterial meningitis and bacterial brain abscess. J Neurosurg 1983;59:735-744.
7. James HE, SchutL. Pitfalls in the diagnosis of arrested hydrocephalus. ActaNeurochir(Wien) 1978;43:13-17.
8. James HE, Walsh JW, Wilson HD, Connor JD, Bean JR, Tibbs PA. Prospective randomized study of therapy in cerebrospinal shunt infection. Neurosurgery 1980;7:459-463.
9. James HE, Walsh JW, Wilson HD, Connor JD. The management of cerebrospinal fluid shunt infections: a clinical experience. ActaNeurochir 1981;59:157-166.
10. James HE, Wilson HD, Connor JD, Walsh JW. Intraventricular cerebrospinal fluid antibiotic concentrations in patients with intraventricular infections. Neurosurgery 1982;10:50-54.
11. Kaufman B A, McLone DG. Infection of cerebrospinal fluid shunts. In Sheld WM, Whitley RJ, Durack DT (eds). Infections of the central nervous system. New York: Raven Press,1991:561-585.
12. Mates S, Glaser J, Shapiro K. Treatment of cerebrospinal fluid shunt infections with medical therapy alone. Neurosurgery 1982;11:781-783.
13. McLaurin RL. Treatment of infected ventricular shunts. Child's Brain 1975;1:306-310.
14. Mori K, Raimondi AJ. An analysis of external ventricular drainage as a treatment for infected shunts. Child's Brain 1975;1:243-250.
15. O'Brien M, Parent A, Davis B. Management of ventricular shunt infections. Child's Brain 1979;5:304-309.
16. Odio C, McCracken GH, Nelson JD. CSF shunt infections in pediatrics. Am J Dis Child 1984;138:1103-1108.
17. Schoenbaum SC, Gardner P, Shillito J. Infections of cerebrospinal fluid shunts: epidemiology, clinical manifestations and therapy. J Infect Dis 1975; 131:543-552.
18. Sells CJ, Shurtleff DB, Loeser JD. Gram-negative cerebrospinal fluid shunt-associated infections. Pediatrics 1977;59:614-618.
19. Stamos JK, Kaffman BA, Yogev R: Ventriculoperitoneal shunt infections with Gram-negative bacteria. Neurosurgery 1993;33:858-862.
20. Yogev R. Cerebrospinal fluid infections: a personal view. Pediatr Infect Dis 1985; 4:113-118.
21. Wald SL McLaurin RL: Shunt-associated glomerulonephritis. Neurosurgery 1978;3:146-150.
22. Wald SL, McLaurin RL. Cerebrospinal fluid antibiotic levels during treatment of shunt infections. J Neurosurg 1980,52:41-46.
23. Walters BC. Cerebrospinal fluid shunt infection. Neurosurg Clin North Am 1992;3:387-401.
24. Walters BC, Hoffman HJ, Hendrick EB, Humpheys RP. Cerebrospinal fluid shunt infection. Influences on initial management and subsequent outcome. J Neurosurg 1984;60:1014-1021.

Datas de Publicação

Publicação nesta coleção
10 Nov 2010
Data do Fascículo
1997

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Choux M, Genitori L, Lang D, Lena G. Shunt implantation: reducing the incidence of shunt infection. J Neurosurg 1992;77:875-880.

[2] 2. Finney HL, Roberts TS. Nephritis secondary to chronic cerebrospinal fluid-vascular shunt infection: "shunt nephritis". Child's Brain 1980;6:189-193.

[3] 3. Forward KR, Fewer HD, Stiver HG. Cerebrospinal fluid shunt infections: a review of 35 infections in 32 patients. J Neurosurg 1983;59:389-394.

[4] 4. Frame PT, McLaurin RL. Treatment of CSF shunt infections with intrashunt plus oral antibiotic therapy. J Neurosurg 1984;60:354-360.

[5] 5. Gardner P, Leipzig T, Phillips P. Infections of the central nervous system shunts. Symposium on infections of the central nervous system. Med Clin North Am 1985;69:297-314.

[6] 6. Garvey G. Current concepts of bacterial infections of the central nervous system-bacterial meningitis and bacterial brain abscess. J Neurosurg 1983;59:735-744.

[7] 7. James HE, SchutL. Pitfalls in the diagnosis of arrested hydrocephalus. ActaNeurochir(Wien) 1978;43:13-17.

[8] 8. James HE, Walsh JW, Wilson HD, Connor JD, Bean JR, Tibbs PA. Prospective randomized study of therapy in cerebrospinal shunt infection. Neurosurgery 1980;7:459-463.

[9] 9. James HE, Walsh JW, Wilson HD, Connor JD. The management of cerebrospinal fluid shunt infections: a clinical experience. ActaNeurochir 1981;59:157-166.

[10] 10. James HE, Wilson HD, Connor JD, Walsh JW. Intraventricular cerebrospinal fluid antibiotic concentrations in patients with intraventricular infections. Neurosurgery 1982;10:50-54.

[11] 11. Kaufman B A, McLone DG. Infection of cerebrospinal fluid shunts. In Sheld WM, Whitley RJ, Durack DT (eds). Infections of the central nervous system. New York: Raven Press,1991:561-585.

[12] 12. Mates S, Glaser J, Shapiro K. Treatment of cerebrospinal fluid shunt infections with medical therapy alone. Neurosurgery 1982;11:781-783.

[13] 13. McLaurin RL. Treatment of infected ventricular shunts. Child's Brain 1975;1:306-310.

[14] 14. Mori K, Raimondi AJ. An analysis of external ventricular drainage as a treatment for infected shunts. Child's Brain 1975;1:243-250.

[15] 15. O'Brien M, Parent A, Davis B. Management of ventricular shunt infections. Child's Brain 1979;5:304-309.

[16] 16. Odio C, McCracken GH, Nelson JD. CSF shunt infections in pediatrics. Am J Dis Child 1984;138:1103-1108.

[17] 17. Schoenbaum SC, Gardner P, Shillito J. Infections of cerebrospinal fluid shunts: epidemiology, clinical manifestations and therapy. J Infect Dis 1975; 131:543-552.

[18] 18. Sells CJ, Shurtleff DB, Loeser JD. Gram-negative cerebrospinal fluid shunt-associated infections. Pediatrics 1977;59:614-618.

[19] 19. Stamos JK, Kaffman BA, Yogev R: Ventriculoperitoneal shunt infections with Gram-negative bacteria. Neurosurgery 1993;33:858-862.

[20] 20. Yogev R. Cerebrospinal fluid infections: a personal view. Pediatr Infect Dis 1985; 4:113-118.

[21] 21. Wald SL McLaurin RL: Shunt-associated glomerulonephritis. Neurosurgery 1978;3:146-150.

[22] 22. Wald SL, McLaurin RL. Cerebrospinal fluid antibiotic levels during treatment of shunt infections. J Neurosurg 1980,52:41-46.

[23] 23. Walters BC. Cerebrospinal fluid shunt infection. Neurosurg Clin North Am 1992;3:387-401.

[24] 24. Walters BC, Hoffman HJ, Hendrick EB, Humpheys RP. Cerebrospinal fluid shunt infection. Influences on initial management and subsequent outcome. J Neurosurg 1984;60:1014-1021.