Main Pathogens in Infection of Different CSF Diversion Techniques in Abo El-Resh Population

Abstract Background: CSF diversion devices’ infection is one of the crucial complications faced in paediatric patients with hydro-cephalus, whether communicating or non-communicating. Yet, it can be prevented mostly by precautious preoperative prepara-tions, intraoperative meticulous sterilization, and intensive ster-ile post-operative wound care. In this study, we are evaluating postoperative CSF devices’ infection according to the clinical presentation, CSF analysis and culture results to apply different management strategies for various situations and the efficacy of these plans to control shunt infection in paediatric age group. Aim of Study: Detection of the main pathogens in CSF infection in different CSF diversion techniques. together with detection of sensitivity patterns among Pathogens. And to set the Most preferable empirical drug used in patients with CSF diversion devices infection in Abo El Reesh Hospital. Patients and Methods: 147 paediatric patients with age group up to 13 years old were studied at Abo El Reesh Hospi-tal, Cairo University Kasr Al-Ainy who had a history of applied different CSF diversion techniques presenting with symptoms and signs suggestive of CSF infection over the duration period of 12 months between April 2019 and April 2020. 68 patients had initial VP shunts applied in Abo El Reesh and 5 EVDs post tumour resection, the rest of the patients had initial VP shunts applied in other hospitals and were referred for further manage-ment of CSF infection. We reviewed the clinical presentation and diagnostic criteria and management strategies used to treat the patients. Results: In 147 paediatric patients with previously inserted CSF diversion device, with a median age of 1.5 years. 81 pa-tients had no culture growth, while 66 patients resulted in 70 culture growth with the most common pathogen was klebsiel-la followed by CoNs. 83% of the patients improved, 12.24% improved with neurological deficit, and 4.76% died. Patients who were treated by conservative management had the highest improvement rate. Conclusion: Proper management strategy includes pre-operative preparation, intraoperative precautions and early diagnostic evaluation considering CSF analysis, clinical pres-entation, and general condition to achieve reduction of CSF diversion devices’ infection.