{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T02:25:20Z","timestamp":1787970320383,"version":"build-2784847793"},"reference-count":22,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,19]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Infection is a significant complication of CSF shunt surgery, with most infections occurring early in the postoperative course. While standardized perioperative protocols have successfully reduced early infections, the epidemiology, risk factors, and clinical patterns of late shunt infections are poorly characterized. This study aimed to determine the incidence, risk factors, clinical features, and outcomes of late shunt infections in a large, multicenter pediatric cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The Hydrocephalus Clinical Research Network (HCRN) Core Data Project was queried for all CSF shunt procedures performed between November 2016 and June 2023 in patients younger than 18 years. Each shunt surgery was treated as an index surgery, defined as the starting point for subsequent infection surveillance. Shunt surgeries were assigned to one of the following categories: no infection, early infection (\u2264 6 months after the surgery), or late infection (&gt; 6 months after the surgery). Demographic, operative, and clinical features of early versus late infections were compared, and Cox proportional hazards models were developed to assess shunt survival following early versus late infections.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Of 6698 shunt procedures, 285 (4.3%) were followed by early infections and 58 (0.9%) by late infections. Late infections accounted for 16.9% of all shunt infections. Late infections were significantly more likely than early infections to be associated with abdominal pseudocysts (24.1% vs 3.5%, p &lt; 0.001) and less likely to be diagnosed via CSF culture (53.4% vs 78.6%, p &lt; 0.001). Clinical events that took place between the shunt surgery and the late infection included abdominal surgeries (21.4%), shunt taps (23.2%), bacteremia (9.1%), and nonoperative abdominal processes requiring hospitalization (19.6%). Vancomycin was administered less frequently in the late infection group (62.1% vs 85.3%, p &lt; 0.001), and shunts were less likely to be initially treated with complete shunt removal (65.5% vs 88.4%, p &lt; 0.001) and more likely to be initially managed with externalization of the distal catheter alone (34.5% vs 11.6%, p &lt; 0.001). Shunt survival after infection did not differ significantly between early and late infections.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Late CSF shunt infections are uncommon but clinically distinct from early infections and are often associated with heterogeneous secondary exposures not addressed by perioperative protocols. These findings highlight the need for long-term surveillance in patients with shunts, tailored diagnostic strategies, and expanded infection tracking efforts.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2026.1.peds25552","type":"journal-article","created":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T00:22:33Z","timestamp":1781655753000},"page":"1-11","source":"Crossref","is-referenced-by-count":0,"title":["Late cerebrospinal fluid shunt infections: a Hydrocephalus Clinical Research Network study"],"prefix":"10.3171","author":[{"given":"David S.","family":"Hersh","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, UConn School of Medicine, Farmington"},{"name":"Division of Neurosurgery, Connecticut Children\u2019s, Hartford, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hailey","family":"Jensen","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Utah, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ron W.","family":"Reeder","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Utah, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nichol","family":"Nunn","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Utah, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Todd C.","family":"Hankinson","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Children\u2019s Hospital Colorado, University of Colorado, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Staulcup","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Children\u2019s Hospital Colorado, University of Colorado, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason S.","family":"Hauptman","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Phoenix Children\u2019s Hospital, Phoenix, Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert M.","family":"Isaacs","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nationwide Children\u2019s Hospital, The Ohio State University College of Medicine, Columbus, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric M.","family":"Jackson","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sydney","family":"White","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhaya V.","family":"Kulkarni","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, The Hospital for Sick Children, University of Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thiemo F.","family":"Dinger","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, The Hospital for Sick Children, University of Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan A.","family":"Pindrik","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nationwide Children\u2019s Hospital, The Ohio State University College of Medicine, Columbus, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian F.","family":"Pollack","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Children\u2019s Hospital Pittsburgh, University of Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Destiney","family":"Davis","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Children\u2019s Hospital Pittsburgh, University of Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Becerra","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Washington, Seattle Children\u2019s Hospital, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vijay M.","family":"Ravindra","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Utah, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay","family":"Riva-Cambrin","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences, University of Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruksana","family":"Rashid","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences, University of Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandon G.","family":"Rocque","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Alabama at Birmingham, Children\u2019s of Alabama, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew T.","family":"Hale","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Alabama at Birmingham, Children\u2019s of Alabama, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamara D.","family":"Simon","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Children\u2019s Hospital Los Angeles, University of Southern California, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer M.","family":"Strahle","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, St. Louis Children\u2019s Hospital, Washington University, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farrell","family":"Landwehr","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, St. Louis Children\u2019s Hospital, Washington University, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mandeep S.","family":"Tamber","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Neurosurgery, British Columbia Children\u2019s Hospital, University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annika","family":"Weir","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Neurosurgery, British Columbia Children\u2019s Hospital, University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John C.","family":"Wellons","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Breanne","family":"Reisen","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William E.","family":"Whitehead","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Department of Neurosurgery, Texas Children\u2019s Hospital, Baylor College of Medicine, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John R. 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Pediatr Neurosci. 1989;15(3):131\u2013135. doi: 10.1159\/000120458"},{"issue":"5","key":"b14","series-title":"Pediatr Neurosurg","first-page":"269","article-title":"Late shunt infections","volume":"31","author":"Baird C","year":"1999","unstructured":"Baird C, O\u2019Connor D, Pittman T. Late shunt infections. Pediatr Neurosurg. 1999;31(5):269\u2013273. doi: 10.1159\/000028874"},{"issue":"3","key":"b15","series-title":"J Pediatric Infect Dis Soc","first-page":"235","article-title":"Patient and treatment characteristics by infecting organism in cerebrospinal fluid shunt infection","volume":"8","author":"Simon TD","year":"2019","unstructured":"Simon TD, Kronman MP, Whitlock KB,  Patient and treatment characteristics by infecting organism in cerebrospinal fluid shunt infection. J Pediatric Infect Dis Soc. 2019;8(3):235\u2013243. doi: 10.1093\/jpids\/piy035"},{"issue":"4","key":"b16","series-title":"Clin Pediatr (Phila)","first-page":"393","article-title":"Late-onset central nervous system shunt infections with Propionibacterium acnes: diagnosis and management","volume":"43","author":"Viraraghavan R","year":"2004","unstructured":"Viraraghavan R, Jantausch B, Campos J. Late-onset central nervous system shunt infections with Propionibacterium acnes: diagnosis and management. Clin Pediatr (Phila). 2004;43(4):393\u2013397. doi: 10.1177\/000992280404300413"},{"issue":"4","key":"b17","series-title":"J Neurosurg Pediatr","first-page":"336","article-title":"What is the risk of infecting a cerebrospinal fluid-diverting shunt with percutaneous tapping?","volume":"14","author":"Spiegelman L","year":"2014","unstructured":"Spiegelman L, Asija R, Da Silva SL, Krieger MD, McComb JG. 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