{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T23:50:18Z","timestamp":1787269818252,"version":"build-2736575974"},"reference-count":66,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,9,1]]},"abstract":"\n OBJECTIVE<\/jats:title>\n \n Cutibacterium acnes<\/jats:italic>\n is a commensal skin and mucosal bacterium that causes CSF shunt infections. The traditional management of\n C. acnes<\/jats:italic>\n shunt infections aligns with the treatment of infections caused by more serious bacteria and consists of shunt removal, external ventricular drainage, and systemic antibiotic administration. Given the relatively benign nature of\n C. acnes<\/jats:italic>\n , such extensive measures may not be required for infection eradication. This study compares the efficacy of a one-stage surgical shunt replacement, omitting the interim external ventricular drainage phase, with the traditional two-stage approach.\n <\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n \n A retrospective data analysis was conducted on the medical records of patients diagnosed with\n C. acnes<\/jats:italic>\n shunt infection between 1997 and 2023. Clinical and diagnostic data were collected.\n <\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n \n Forty-three patients with\n C. acnes<\/jats:italic>\n shunt infection were identified. Of these patients, 26 underwent traditional two-stage shunt replacement with intervening external ventricular drainage, and 14 underwent one-stage shunt replacement without an interim external drainage period. Nine patients underwent endoscopic third ventriculostomy in an attempt to achieve shunt independence.\n C. acnes<\/jats:italic>\n shunt infection was cleared in all patients with no recurrence at median follow-up periods of 7.08 years and 9.05 years for the one-stage and two-stage replacement groups, respectively.\n <\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n \n The findings indicate that one-stage shunt replacement surgery without intervening externalization is an effective treatment option for\n C. acnes<\/jats:italic>\n shunt infections. In addition to eliminating the need for multiple surgical interventions, this approach shortens hospital stays, thereby reducing healthcare costs and minimizing patients\u2019 exposure to hospital-associated risks. This study supports a reevaluation of current guidelines for treating shunt infections, advocating for more flexible, patient-centered approaches that consider the pathogenicity of offending organisms such as\n C. acnes<\/jats:italic>\n .\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2025.3.peds24539","type":"journal-article","created":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T23:13:32Z","timestamp":1751066012000},"page":"278-285","source":"Crossref","is-referenced-by-count":2,"title":["Effectiveness of single-stage shunt replacement for Cutibacterium acnes CSF shunt infection"],"prefix":"10.3171","volume":"36","author":[{"given":"Anas","family":"Abou Merhi","sequence":"first","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roy","family":"Chebel","sequence":"additional","affiliation":[{"name":"Surgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joyce","family":"Koueik","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Pinto","sequence":"additional","affiliation":[{"name":"Biostatistics and Medical Informatics, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ambar","family":"Haleem","sequence":"additional","affiliation":[{"name":"Division of Infectious Disease, Department of Medicine, University of Wisconsin, Madison, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bermans J.","family":"Iskandar","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"6","key":"b1","series-title":"Clin Infect Dis","first-page":"e34","article-title":"2017 Infectious Diseases Society of America\u2019s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis","volume":"64","author":"Tunkel AR","year":"2017","unstructured":"Tunkel AR, Hasbun R, Bhimraj A, 2017 Infectious Diseases Society of America\u2019s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis. Clin Infect Dis. 2017;64(6):e34\u2013e65."},{"issue":"12","key":"b2","series-title":"Expert Rev Anti Infect Ther","first-page":"1149","article-title":"Propionibacterium acnes: infection beyond the skin","volume":"9","author":"Perry A","year":"2011","unstructured":"Perry A, Lambert P. Propionibacterium acnes: infection beyond the skin. Expert Rev Anti Infect Ther. 2011;9(12):1149\u20131156."},{"issue":"9","key":"b3","series-title":"Clin Infect Dis","first-page":"1267","article-title":"Practice guidelines for the management of bacterial meningitis","volume":"39","author":"Tunkel AR","year":"2004","unstructured":"Tunkel AR, Hartman BJ, Kaplan SL, Practice guidelines for the management of bacterial meningitis. Clin Infect Dis. 2004;39(9):1267\u20131284."},{"issue":"8","key":"b4","series-title":"Childs Nerv Syst","first-page":"378","article-title":"Propionibacterium [correction of Proprionibacterium] acnes infections of cerebrospinal fluid shunts","volume":"14","author":"Thompson TP","year":"1998","unstructured":"Thompson TP, Albright AL. Propionibacterium [correction of Proprionibacterium] acnes infections of cerebrospinal fluid shunts. Childs Nerv Syst. 1998;14(8):378\u2013380."},{"issue":"1","key":"b5","series-title":"Acta Neurochir (Wien)","first-page":"33","article-title":"Propionebacterium acnes in cultures from ventriculo-peritoneal shunts: infection or contamination","volume":"139","author":"Westergren H","year":"1997","unstructured":"Westergren H, Westergren V, Forsum U. Propionebacterium acnes in cultures from ventriculo-peritoneal shunts: infection or contamination? Acta Neurochir (Wien). 1997;139(1):33\u201336."},{"issue":"6","key":"b6","series-title":"Am J Med","first-page":"935","article-title":"Propionibacterium acnes: pathogen in central nervous system shunt infection. Report of three cases including immune complex glomerulonephritis","volume":"61","author":"Beeler BA","year":"1976","unstructured":"Beeler BA, Crowder JG, Smith JW, White A. Propionibacterium acnes: pathogen in central nervous system shunt infection. Report of three cases including immune complex glomerulonephritis. Am J Med. 1976;61(6):935\u2013938."},{"key":"b7","series-title":"Biomed Res Int","first-page":"804391","article-title":"Propionibacterium acnes: an underestimated pathogen in implant-associated infections","volume":"2013","author":"Portillo ME","year":"2013","unstructured":"Portillo ME, Corvec S, Borens O, Trampuz A. Propionibacterium acnes: an underestimated pathogen in implant-associated infections. Biomed Res Int. 2013;2013:804391."},{"issue":"5","key":"b8","series-title":"J Neurosurg Pediatr","first-page":"366","article-title":"Cerebrospinal fluid shunt infections in children over a 13-year period: anaerobic cultures and comparison of clinical signs of infection with Propionibacterium acnes and with other bacteria","volume":"1","author":"Arnell K","year":"2008","unstructured":"Arnell K, Cesarini K, Lagerqvist-Widh A, Wester T, Sj\u00f6lin J. Cerebrospinal fluid shunt infections in children over a 13-year period: anaerobic cultures and comparison of clinical signs of infection with Propionibacterium acnes and with other bacteria. J Neurosurg Pediatr. 2008;1(5):366\u2013372."},{"issue":"4","key":"b9","series-title":"J Neurosurg","first-page":"617","article-title":"The significance of bacteriologically positive ventriculoperitoneal shunt components in the absence of other signs of shunt infection","volume":"84","author":"Steinbok P","year":"1996","unstructured":"Steinbok P, Cochrane DD, Kestle JR. The significance of bacteriologically positive ventriculoperitoneal shunt components in the absence of other signs of shunt infection. J Neurosurg. 1996;84(4):617\u2013623."},{"issue":"4","key":"b10","series-title":"Infect Immun","first-page":"e00531","article-title":"Cutibacterium acnes central nervous system catheter infection induces long-term changes in the cerebrospinal fluid proteome","volume":"89","author":"Beaver M","year":"2021","unstructured":"Beaver M, Lagundzin D, Thapa I, Cutibacterium acnes central nervous system catheter infection induces long-term changes in the cerebrospinal fluid proteome. Infect Immun. 2021;89(4):e00531\u201320."},{"issue":"4","key":"b11","series-title":"Infect Immun","first-page":"e00753","article-title":"Cutibacterium acnes: the urgent need to identify diagnosis markers","volume":"89","author":"Mongaret C","year":"2021","unstructured":"Mongaret C, Velard F, Reffuveille F. Cutibacterium acnes: the urgent need to identify diagnosis markers. Infect Immun. 2021;89(4):e00753\u201320."},{"issue":"3 suppl","key":"b12","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 K","year":"2007","unstructured":"Arnell K, Enblad P, Wester T, Sj\u00f6lin J. 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. J Neurosurg. 2007;107(3 suppl):213\u2013219."},{"issue":"7","key":"b13","series-title":"Pediatr Infect Dis J","first-page":"632","article-title":"Treatment of cerebrospinal fluid shunt infections: a decision analysis","volume":"21","author":"Schreffler RT","year":"2002","unstructured":"Schreffler RT, Schreffler AJ, Wittler RR. Treatment of cerebrospinal fluid shunt infections: a decision analysis. Pediatr Infect Dis J. 2002;21(7):632\u2013636."},{"issue":"1","key":"b14","series-title":"J Neurosurg","first-page":"21","article-title":"Infected ventriculoatrial shunts: a method of treatment","volume":"27","author":"Perrin JCS","year":"1967","unstructured":"Perrin JCS, McLaurin RL. Infected ventriculoatrial shunts: a method of treatment. J Neurosurg. 1967;27(1):21\u201326."},{"issue":"1","key":"b15","series-title":"Pediatrics","first-page":"55","article-title":"Therapy of Staphylococcus epidermidis: infections associated with cerebrospinal fluid shunts","volume":"53","author":"Shurtleff DB","year":"1974","unstructured":"Shurtleff DB, Foltz EL, Weeks RD, Loeser J. Therapy of Staphylococcus epidermidis: infections associated with cerebrospinal fluid shunts. Pediatrics. 1974;53(1):55\u201362."},{"issue":"4","key":"b16","series-title":"Pediatrics","first-page":"614","article-title":"Gram-negative cerebrospinal fluid shunt-associated infections","volume":"59","author":"Sells CJ","year":"1977","unstructured":"Sells CJ, Shurtleff DB, Loeser JD. Gram-negative cerebrospinal fluid shunt-associated infections. Pediatrics. 1977;59(4):614\u2013618."},{"issue":"3","key":"b17","series-title":"Childs Brain","first-page":"304","article-title":"Management of ventricular shunt infections","volume":"5","author":"O\u2019Brien M","year":"1979","unstructured":"O\u2019Brien M, Parent A, Davis B. Management of ventricular shunt infections. Childs Brain. 1979;5(3):304\u2013309."},{"issue":"3","key":"b18","series-title":"J Neurosurg","first-page":"389","article-title":"Cerebrospinal fluid shunt infections. A review of 35 infections in 32 patients","volume":"59","author":"Forward KR","year":"1983","unstructured":"Forward KR, Fewer HD, Stiver HG. Cerebrospinal fluid shunt infections. A review of 35 infections in 32 patients. J Neurosurg. 1983;59(3):389\u2013394."},{"issue":"5","key":"b19","series-title":"J Neurosurg","first-page":"1014","article-title":"Cerebrospinal fluid shunt infection: influences on initial management and subsequent outcome","volume":"60","author":"Walters BC","year":"1984","unstructured":"Walters BC, Hoffman HJ, Hendrick EB, Humphreys RP. Cerebrospinal fluid shunt infection: influences on initial management and subsequent outcome. J Neurosurg. 1984;60(5):1014\u20131021."},{"issue":"3-4","key":"b20","series-title":"Acta Neurochir (Wien)","first-page":"157","article-title":"The management of cerebrospinal fluid shunt infections: a clinical experience","volume":"59","author":"James HE","year":"1981","unstructured":"James HE, Walsh JW, Wilson HD, Connor JD. The management of cerebrospinal fluid shunt infections: a clinical experience. Acta Neurochir (Wien). 1981;59(3-4):157\u2013166."},{"issue":"3 suppl","key":"b21","series-title":"J Neurosurg","first-page":"177","article-title":"Management of shunt infections: a multicenter pilot study","volume":"105","author":"Kestle JRW","year":"2006","unstructured":"Kestle JRW, Garton HJL, Whitehead WE, Management of shunt infections: a multicenter pilot study. J Neurosurg. 2006;105(3 suppl):177\u2013181."},{"issue":"5","key":"b22","series-title":"Neurosurgery","first-page":"459","article-title":"Prospective randomized study of therapy in cerebrospinal fluid shunt infection","volume":"7","author":"James HE","year":"1980","unstructured":"James HE, Walsh JW, Wilson HD, Connor JD, Bean JR, Tibbs PA. Prospective randomized study of therapy in cerebrospinal fluid shunt infection. Neurosurgery. 1980;7(5):459\u2013463."},{"issue":"2","key":"b23","series-title":"Pediatr Infect Dis","first-page":"113","article-title":"Cerebrospinal fluid shunt infections: a personal view","volume":"4","author":"Yogev R","year":"1985","unstructured":"Yogev R. Cerebrospinal fluid shunt infections: a personal view. Pediatr Infect Dis. 1985;4(2):113\u2013118."},{"issue":"1","key":"b24","series-title":"J Neurosurg Pediatr","first-page":"22","article-title":"A standardized protocol to reduce cerebrospinal fluid shunt infection: the Hydrocephalus Clinical Research Network Quality Improvement Initiative","volume":"8","author":"Kestle JRW","year":"2011","unstructured":"Kestle JRW, Riva-Cambrin J, Wellons JC, A standardized protocol to reduce cerebrospinal fluid shunt infection: the Hydrocephalus Clinical Research Network Quality Improvement Initiative. J Neurosurg Pediatr. 2011;8(1):22\u201329."},{"issue":"suppl 22","key":"b25","series-title":"Dev Med Child Neurol Suppl","article-title":"Immediate shunt replacement in the treatment of bacterial colonisation of Holter valves","volume":"22","author":"Nicholas JL","year":"1970","unstructured":"Nicholas JL, Kamal IM, Eckstein HB. Immediate shunt replacement in the treatment of bacterial colonisation of Holter valves. Dev Med Child Neurol Suppl. 1970;22(suppl 22):110+."},{"issue":"4","key":"b26","series-title":"J Neurosurg","first-page":"423","article-title":"Adult hydrocephalus: evaluation of shunt therapy in 80 patients","volume":"37","author":"Salmon JH","year":"1972","unstructured":"Salmon JH. Adult hydrocephalus: evaluation of shunt therapy in 80 patients. 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World Neurosurg. 2023;171:41\u201364."},{"issue":"11 suppl 2","key":"b29","series-title":"Hawaii J Health Soc Welf","first-page":"3","article-title":"Cutibacterium acnes (formerly Proprionibacterium acnes) and shoulder surgery","volume":"78","author":"Elston MJ","year":"2019","unstructured":"Elston MJ, Dupaix JP, Opanova MI, Atkinson RE. Cutibacterium acnes (formerly Proprionibacterium acnes) and shoulder surgery. Hawaii J Health Soc Welf. 2019;78(11 suppl 2):3\u20135."},{"issue":"1","key":"b30","series-title":"Clin Infect Dis","first-page":"e1","article-title":"Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America","volume":"56","author":"Osmon DR","year":"2013","unstructured":"Osmon DR, Berbari EF, Berendt AR, Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. 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Open Forum Infect Dis. 2023;10(8):ofad370."},{"issue":"11","key":"b32","series-title":"Eur J Clin Microbiol Infect Dis","first-page":"739","article-title":"Arthroplastic and osteosynthetic infections due to Propionibacterium acnes: a retrospective study of 52 cases, 1995\u20132002","volume":"24","author":"Lutz MF","year":"2005","unstructured":"Lutz MF, Berthelot P, Fresard A, Arthroplastic and osteosynthetic infections due to Propionibacterium acnes: a retrospective study of 52 cases, 1995\u20132002. Eur J Clin Microbiol Infect Dis. 2005;24(11):739\u2013744."},{"issue":"1S","key":"b33","series-title":"Orthop Traumatol Surg Res","first-page":"S19","article-title":"Cutibacterium acnes prosthetic joint infection: diagnosis and treatment","volume":"104","author":"Boisrenoult P","year":"2018","unstructured":"Boisrenoult P. Cutibacterium acnes prosthetic joint infection: diagnosis and treatment. Orthop Traumatol Surg Res. 2018;104(1S):S19\u2013S24."},{"issue":"6","key":"b1","series-title":"Clin Infect Dis","first-page":"e34","article-title":"2017 Infectious Diseases Society of America\u2019s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis","volume":"64","author":"Tunkel AR","year":"2017","unstructured":"Tunkel AR, Hasbun R, Bhimraj A, 2017 Infectious Diseases Society of America\u2019s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis. Clin Infect Dis. 2017;64(6):e34\u2013e65."},{"issue":"12","key":"b2","series-title":"Expert Rev Anti Infect Ther","first-page":"1149","article-title":"Propionibacterium acnes: infection beyond the skin","volume":"9","author":"Perry A","year":"2011","unstructured":"Perry A, Lambert P. Propionibacterium acnes: infection beyond the skin. 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Childs Nerv Syst. 1998;14(8):378\u2013380."},{"issue":"1","key":"b5","series-title":"Acta Neurochir (Wien)","first-page":"33","article-title":"Propionebacterium acnes in cultures from ventriculo-peritoneal shunts: infection or contamination","volume":"139","author":"Westergren H","year":"1997","unstructured":"Westergren H, Westergren V, Forsum U. Propionebacterium acnes in cultures from ventriculo-peritoneal shunts: infection or contamination? Acta Neurochir (Wien). 1997;139(1):33\u201336."},{"issue":"6","key":"b6","series-title":"Am J Med","first-page":"935","article-title":"Propionibacterium acnes: pathogen in central nervous system shunt infection. Report of three cases including immune complex glomerulonephritis","volume":"61","author":"Beeler BA","year":"1976","unstructured":"Beeler BA, Crowder JG, Smith JW, White A. Propionibacterium acnes: pathogen in central nervous system shunt infection. Report of three cases including immune complex glomerulonephritis. Am J Med. 1976;61(6):935\u2013938."},{"key":"b7","series-title":"Biomed Res Int","first-page":"804391","article-title":"Propionibacterium acnes: an underestimated pathogen in implant-associated infections","volume":"2013","author":"Portillo ME","year":"2013","unstructured":"Portillo ME, Corvec S, Borens O, Trampuz A. Propionibacterium acnes: an underestimated pathogen in implant-associated infections. Biomed Res Int. 2013;2013:804391."},{"issue":"5","key":"b8","series-title":"J Neurosurg Pediatr","first-page":"366","article-title":"Cerebrospinal fluid shunt infections in children over a 13-year period: anaerobic cultures and comparison of clinical signs of infection with Propionibacterium acnes and with other bacteria","volume":"1","author":"Arnell K","year":"2008","unstructured":"Arnell K, Cesarini K, Lagerqvist-Widh A, Wester T, Sj\u00f6lin J. Cerebrospinal fluid shunt infections in children over a 13-year period: anaerobic cultures and comparison of clinical signs of infection with Propionibacterium acnes and with other bacteria. J Neurosurg Pediatr. 2008;1(5):366\u2013372."},{"issue":"4","key":"b9","series-title":"J Neurosurg","first-page":"617","article-title":"The significance of bacteriologically positive ventriculoperitoneal shunt components in the absence of other signs of shunt infection","volume":"84","author":"Steinbok P","year":"1996","unstructured":"Steinbok P, Cochrane DD, Kestle JR. The significance of bacteriologically positive ventriculoperitoneal shunt components in the absence of other signs of shunt infection. J Neurosurg. 1996;84(4):617\u2013623."},{"issue":"4","key":"b10","series-title":"Infect Immun","first-page":"e00531","article-title":"Cutibacterium acnes central nervous system catheter infection induces long-term changes in the cerebrospinal fluid proteome","volume":"89","author":"Beaver M","year":"2021","unstructured":"Beaver M, Lagundzin D, Thapa I, Cutibacterium acnes central nervous system catheter infection induces long-term changes in the cerebrospinal fluid proteome. Infect Immun. 2021;89(4):e00531\u201320."},{"issue":"4","key":"b11","series-title":"Infect Immun","first-page":"e00753","article-title":"Cutibacterium acnes: the urgent need to identify diagnosis markers","volume":"89","author":"Mongaret C","year":"2021","unstructured":"Mongaret C, Velard F, Reffuveille F. Cutibacterium acnes: the urgent need to identify diagnosis markers. Infect Immun. 2021;89(4):e00753\u201320."},{"issue":"3 suppl","key":"b12","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 K","year":"2007","unstructured":"Arnell K, Enblad P, Wester T, Sj\u00f6lin J. 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. 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J Neurosurg. 1983;59(3):389\u2013394."},{"issue":"5","key":"b19","series-title":"J Neurosurg","first-page":"1014","article-title":"Cerebrospinal fluid shunt infection: influences on initial management and subsequent outcome","volume":"60","author":"Walters BC","year":"1984","unstructured":"Walters BC, Hoffman HJ, Hendrick EB, Humphreys RP. Cerebrospinal fluid shunt infection: influences on initial management and subsequent outcome. J Neurosurg. 1984;60(5):1014\u20131021."},{"issue":"3-4","key":"b20","series-title":"Acta Neurochir (Wien)","first-page":"157","article-title":"The management of cerebrospinal fluid shunt infections: a clinical experience","volume":"59","author":"James HE","year":"1981","unstructured":"James HE, Walsh JW, Wilson HD, Connor JD. The management of cerebrospinal fluid shunt infections: a clinical experience. 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