{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T11:17:10Z","timestamp":1761823030309},"reference-count":44,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["PED"],"published-print":{"date-parts":[[2008,3]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>The authors present their experience with a protocol for the treatment of patients with complicated shunt infections.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>Complicated shunt infections are defined for the purpose of this protocol as multiple compartment hydrocephalus, multiple organism shunt infection, severe peritonitis, or infections in other sites of the body. The initial treatment protocol for these patients was 3 weeks of intravenous antibiotic therapy and 2 weeks of twice daily intraventricular\/intrashunt antibiotic therapy. Cerebrospinal fluid (CSF) cultures were monitored during therapy and obtained again 48 hours after completion. The shunt was completely replaced. Additionally, follow-up cultures were obtained in all patients 3\u20136 months after therapy was completed.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>A cure of the infection was achieved in all patients as defined by negative cultures obtained at completion of antibiotic therapy and in follow-up studies. The follow-up period was 2\u201311 years (mean 4.4 \u00b1 2.5 years). The treatment protocol was modified in the patients treated after 1991, and 18 patients were treated with this modified treatment regime. In these patients, intraventricular antibiotics were administered only once daily for 14 days, and the CSF was cultured 24 hours after antibiotic therapy had been stopped instead of after 48 hours. The results were similar to those obtained with the initial protocol.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Based on their prospective nonrandomized series, the authors believe that patients with complicated shunt infections can be successfully treated with 2 weeks of intraventricular antibiotic therapy administered once daily, concurrent with 3 weeks of intravenous antibiotic therapy. This protocol reduces length of treatment and hospital stay, and avoids recurrence of infection.<\/jats:p><\/jats:sec>","DOI":"10.3171\/ped\/2008\/1\/3\/223","type":"journal-article","created":{"date-parts":[[2008,2,29]],"date-time":"2008-02-29T18:54:07Z","timestamp":1204311247000},"page":"223-228","source":"Crossref","is-referenced-by-count":15,"title":["Management of complicated shunt infections: a clinical report"],"prefix":"10.3171","volume":"1","author":[{"given":"Hector E.","family":"James","sequence":"first","affiliation":[{"name":"Lucy Gooding Pediatric Neurosurgery Center, University of Florida Health Sciences Center, and Wolfson Children's Hospital Jacksonville, Florida; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John S.","family":"Bradley","sequence":"additional","affiliation":[{"name":"Children's Hospital and Health Center, San Diego, California"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-0010223","series-title":"Pediatr Neurosurg","doi-asserted-by":"publisher","first-page":"256","DOI":"10.1159\/000058429","article-title":"Duration of antibiotic therapy for the treatment of shunt infection: a surgeon and patient survey","volume":"36","author":"Arthur","year":"2002"},{"key":"b2-0010223","series-title":"Pediatr Neurosurg","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1159\/000028874","article-title":"Late shunt infections","volume":"31","author":"Baird","year":"1999"},{"key":"b3-0010223","series-title":"Dev Med Child Neurol Suppl","first-page":"25","article-title":"Excessive production of mucoid substance in staphylococcus SIIA: a possible factor in colonisation of Holter shunts","volume":"27","author":"Bayston","year":"1972"},{"key":"b4-0010223","series-title":"Antibiotics Annals","first-page":"1133","article-title":"Use of the gradient plate for routine clinical determinations of bacterial sensitivities to antibiotics","author":"Braude","year":"1954\/1955"},{"key":"b5-0010223","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"657","DOI":"10.1227\/01.NEU.0000204126.54417.46","article-title":"Conservative management of patients with cerebrospinal fluid shunt infections","volume":"58","author":"Brown","year":"2006"},{"key":"b6-0010223","series-title":"Dev Med Child Neurol","first-page":"461","article-title":"Persistent bacteraemia following ventriculocaval shunt operations for hydrocephalus in infants","volume":"25","author":"Bruce","year":"1963"},{"key":"b7-0010223","series-title":"Br Med J","doi-asserted-by":"publisher","first-page":"677","DOI":"10.1136\/bmj.2.5253.677","article-title":"A syndrome due to the bacterial colonization of Spitz-Holter valves. 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