Estudo comparativo em diferentes condutas de manejo do dispositivo de Derivação Ventriculoperitoneal Infectada e seus fatores de sucesso

Abstract

Background: The ventriculoperitoneal shunt (VPS) is the most common treatment for hydrocephalus. However, this procedure presents an infection rate between 0.33 and 30%, whose management is quite challenging. The most frequently recommended strategy is its removal, followed by external ventricular drain (EVD) with systemic antibiotic therapy. Other options are partial shunt hardware removal (externalization) or systemic antibiotic alone, both replacing a new VPS system after the proper treatment. Methods: 86 patients’ historical cohort with the infected system operated in an academic Brazilian hospital from 2007 to 2021. All patients received a systemic antibiotic, and a new contralateral VPS was placed if the cytometry was less than 50 cells/mm3 with a negative cerebrospinal fluid (CSF) culture. They were divided into groups and compared: 1) system maintenance; 2) externalization of the distal catheter; or 3) EVD. Failure was considered as reinfection within six months or a conduct change. Results and discussion: All groups were homogeneous and comparable concerning sex, microorganism isolated at admission, age, and total antibiotic time. Fever was the most prevalent sign (76.7%), while 29% had local infection signs. Staphylococcus epidermidis (24,4%) and S. aureus (10,5%) accounted for most organisms cultured, similar to the literature. Most of them were multidrug-resistant (51,8%), with vancomycin used in 83.7% of all cases. Patients with failure had a higher admission cytometry count (mean 1,036 cells/mm3; p-value < 0,05). There was a failure in 25% of group 1 (10/40), 53,9% in group 2 (7/13), and 24,2% in group 3 (8/33), but no difference between groups about the failure was found (p=0,117). Reimplantation catheter culture, age, total antibiotic therapy time, or reimplantation cytometry value was also not predictors of failure. Conclusion: The management of VPS infection in all groups had a similar success rate. Hence, conservative conduct, without an EVD implant, can be tried in advance, considering the costs.