The utility of broad-range polymerase chain reaction (PCR) may be limited by contamination with skin flora during collection and handling as well as antibiotic administration before a diagnosis is made. While DNA sequencing methods for microbiological diagnosis are promising, they also have pitfalls, particularly in the case of shunt infection where many sequenced pathogens are common skin flora. While newer DNA-based detection methods are being instituted in the clinical microbiology laboratory, the gold standard method to diagnose shunt infection currently relies on isolating a pathogen from CSF culture. With the extensive nature of treatment, it is essential that shunt infections are diagnosed accurately and rapidly. Due to their biofilm nature, shunt infection treatment requires both removal of the infected shunt and days or weeks of intravenous antibiotics. Thus, the inflammatory response to biofilm infection is distinct from planktonic infection, such as bacterial meningitis or intracranial abscess. Bacteria adhere to the catheter and form a biofilm, communities of bacteria which are tolerant to antibiotics and actively avoid immune clearance. Shunt infections present unique diagnostic and treatment challenges, since they are biofilm rather than planktonic infections. Apart from staphylococci, Propionibacterium acnes, enterococci, and a variety of gram-negative bacteria including Pseudomonas aeruginosa and Escherichia coli commonly cause shunt infections. Bacteria cause the majority of shunt infections, with Staphylococcus epidermidis and Staphylococcus aureus among the leading causes. Shunt infections are responsible for approximately 2400 admissions and 59,000 hospital days annually in the USA. Additionally, it demonstrates the potential of CSF chemokines and cytokines as biomarkers for the diagnosis of shunt infection.Ĭerebrospinal fluid (CSF) shunts are the most common treatment of hydrocephalus in the USA however, they are frequently complicated by bacterial infection. This pilot study is the first to characterize the CSF cytokine profile in patients with CSF shunt infection and supports the distinction of chemokine and cytokine profiles between gram-negative and gram-positive infections. CSF from gram-positive and gram-negative shunt infections had similar levels of interferon gamma (INF-γ), tumor necrosis factor alpha (TNF-α), IL-6, and IL-8. Conversely, gram-negative infections displayed higher levels of the pro-inflammatory cytokines IL-1β, fractalkine (CX 3CL 1), chemokine ligand 2 (CCL2), and chemokine ligand 3 (CC元), although again these were not significantly different. An interesting trend was observed with gram-positive infections having higher levels of the anti-inflammatory cytokine interleukin (IL)-10 as well as IL-17A and vascular endothelial growth factor (VEGF) compared to gram-negative infections, although these differences did not reach statistical significance. Those with shunt infection had a median CSF WBC of 332 cells/mL, median CSF protein level of 406 mg/dL, and median CSF glucose of 35.5 mg/dL. Median peripheral white blood cell count was 15.53 × 10 3 cells/mL. Patients with shunt infection had a median C-reactive protein (CRP) of 18.25 mg/dL. ResultsĪ total of 12 infections were included in this study. CSF cytokine analysis was performed for those patients with CSF in frozen storage from the same sample that was used for diagnostic culture. We conducted a retrospective chart review of children with culture-confirmed CSF shunt infection at Children’s Hospital and Medical Center from July 2013 to December 2015. The objective of this study was to evaluate the potential of systemic and CSF biomarkers for identification of CSF shunt infection. CSF chemokines and cytokines may prove useful as diagnostic biomarkers. New methods are needed to swiftly and accurately diagnose shunt infections. Negative cultures present a conundrum for physicians as they are left to rely on other CSF indices, which can be unremarkable. Shunt infection diagnosis relies on bacterial culture of CSF which can often produce false-negative results. Cerebrospinal fluid (CSF) shunt placement is frequently complicated by bacterial infection.
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