{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T22:54:55Z","timestamp":1787698495648,"version":"build-2784847793"},"reference-count":37,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"Supplement_1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["PED"],"published-print":{"date-parts":[[2014,11]]},"abstract":"\nObject<\/jats:title>\nThe objective of this systematic review was to answer the following question: What is the optimal treatment strategy for CSF shunt infection in pediatric patients with hydrocephalus?<\/jats:p><\/jats:sec>\n\nMethods<\/jats:title>\nThe US National Library of Medicine and the Cochrane Database of Systematic Reviews were queried using MeSH headings and key words relevant to the objective of this systematic review. Abstracts were reviewed, after which studies meeting the inclusion criteria were selected and graded according to their quality of evidence (Classes I\u2013III). Evidentiary tables were constructed that summarized pertinent study results, and based on the quality of the literature, recommendations were made (Levels I\u2013III).<\/jats:p><\/jats:sec>\n\nResults<\/jats:title>\nA review and critical appraisal of 27 studies that met the inclusion criteria allowed for a recommendation for supplementation of antibiotic treatment using partial (externalization) or complete shunt hardware removal, with a moderate degree of clinical certainty. However, a recommendation regarding whether complete shunt removal is favored over partial shunt removal (that is, externalization) could not be made owing to severe methodological deficiencies in the existing literature. There is insufficient evidence to recommend the use of intrathecal antibiotic therapy as an adjunct to systemic antibiotic therapy in the management of routine CSF shunt infections. This also holds true for other clinical scenarios such as when an infected CSF shunt cannot be completely removed, when a shunt must be removed and immediately replaced in the face of ongoing CSF infection, or when the setting is ventricular shunt infection caused by specific organisms (for example, gram-negative bacteria).<\/jats:p><\/jats:sec>\n\nConclusions<\/jats:title>\nSupplementation of antibiotic treatment with partial (externalization) or complete shunt hardware removal are options in the management of CSF shunt infection. There is insufficient evidence to recommend either shunt externalization or complete shunt removal as the preferred surgical strategy for the management of CSF shunt infection. Therefore, clinical judgment is required. In addition, there is insufficient evidence to recommend the combination of intrathecal and systemic antibiotics for patients with CSF shunt infection when the infected shunt hardware cannot be fully removed, when the shunt must be removed and immediately replaced, or when the CSF shunt infection is caused by specific organisms. The potential neurotoxicity of intrathecal antibiotic therapy may limit its routine use.<\/jats:p>\nRecommendation<\/jats:sc>: Supplementation of antibiotic treatment with partial (externalization) or with complete shunt hardware removal is an option in the management of CSF shunt infection. Strength<\/jats:sc> of Recommendation<\/jats:sc>: Level II, moderate degree of clinical certainty.<\/jats:p>\nRecommendation<\/jats:sc>: There is insufficient evidence to recommend either shunt externalization or complete shunt removal as a preferred surgical strategy for the management of CSF shunt infection. Therefore, clinical judgment is required. Strength<\/jats:sc> of Recommendation<\/jats:sc>: Level III, unclear degree of clinical certainty.<\/jats:p>\nRecommendation<\/jats:sc>: There is insufficient evidence to recommend the combination of intrathecal and systemic antibiotics for patients with CSF shunt infection in whom the infected shunt hardware cannot be fully removed or must be removed and immediately replaced, or when the CSF shunt infection is caused by specific organisms. The potential neurotoxicity of intrathecal antibiotic therapy may limit its routine use. Strength of Recommendation: Level III, unclear degree of clinical certainty.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2014.7.peds14328","type":"journal-article","created":{"date-parts":[[2015,5,19]],"date-time":"2015-05-19T18:45:05Z","timestamp":1432061105000},"page":"60-71","source":"Crossref","is-referenced-by-count":68,"title":["Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 8: Management of cerebrospinal fluid shunt infection"],"prefix":"10.3171","volume":"14","author":[{"given":"Mandeep S.","family":"Tamber","sequence":"first","affiliation":[{"name":"Department of Pediatric Neurological Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Klimo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, and"},{"name":"Le Bonheur Children's Hospital, Memphis, Tennessee;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine A.","family":"Mazzola","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurological Surgery, Goryeb Children's Hospital, Morristown, New Jersey; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann Marie","family":"Flannery","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Saint Louis University, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-60-71","series-title":"Pediatr Infecti Dis J","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1097\/01.inf.0000165307.29619.82","article-title":"A rational approach to the management of ventricular shunt infections","volume":"24","author":"Anderson","year":"2005"},{"issue":"3 Suppl","key":"b2-60-71","series-title":"J Neurosurg","first-page":"213","article-title":"Treatment of cerebrospinal fluid shunt infections in children using systemic and intraventricular antibiotic therapy in combination with externalization of the ventricular catheter: efficacy in 34 consecutively treated infections","volume":"107","author":"Arnell","year":"2007"},{"key":"b3-60-71","series-title":"Z Kinderchir","first-page":"339","article-title":"Factors involved in the antibiotic treatment of cerebrospinal fluid shunt infections","volume":"34","author":"Bayston","year":"1981"},{"key":"b4-60-71","series-title":"Clin Pharm","first-page":"866","article-title":"Treatment and prevention of infections of cerebrospinal fluid shunts","volume":"6","author":"Fan-Havard","year":"1987"},{"key":"b5-60-71","series-title":"J Neurosurg Pediatr (Suppl)","doi-asserted-by":"publisher","first-page":"3","DOI":"10.3171\/2014.7.PEDS14321","article-title":"Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. 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