Chapters authored
Infections in CSF Shunts and External Ventricular Drainage
Infection in those with hydrocephalus shunts or external drains (EVDs) can cause serious central nervous system damage with lasting sequelae. The infections usually involve bacterial colonisation and biofilm formation in the catheters. The nature and sources of pathogens and preventive measures are discussed. The risks of infection in shunts and EVDs is different. Infection in shunts is almost always initiated at their insertion or revision (exceptions are described). In contrast, in EVDs, the risk of infection persists throughout their use. The pathogen profile is also different. These factors are important considerations when planning preventive measures. Newer strategies such as antimicrobial catheters are discussed. Diagnosis of EVD infections in an already ill patient is difficult but guidelines can be useful. Treatment of the shunt and EVD infections are also addressed, with reference to modes and routes of antibiotic administration.
Part of the book: Cerebrospinal Fluid
Molecular Pathogenesis and Clinical Impact of Biofilms in Surgery
Biofilms are responsible for chronic persistent infections and are a major problem in implant surgery. The microbial pathogenesis, treatment and prevention of biofilm infections is reviewed.
Part of the book: Focus on Bacterial Biofilms
Infections in Intracranial Pressure Management: Impact of New Technologies on Infection Rates
It is now recognised that infections in CSF shunts and external ventricular drains (EVDs) are biofilm infections, and the scientific basis of these infections is better understood. Infection rates in shunts have now fallen but remain unacceptably high. There is an increase in infections due to multi-drug-resistant bacteria in EVDs. Reliance on antimicrobial prophylaxis has potential lifethreatening consequences and safer more effective measures are available. These consist of well-founded “bundles” or surgical protocols that have been shown to reduce infection by application of well known but not universally applied principles. New developments in antimicrobial technology have now been shown to be clinically effective and have reduced healthcare costs. The reduction in antibiotic use has led to fewer adverse effects. Problems with multidrug resistance in EVD infections remain and technology to address these has been developed but is not yet clinically available.
Part of the book: Frontiers in Hydrocephalus