ArticleCureus2025
Microbial Diversity and Infection Burden in Central Nervous System (CNS) Shunt and Drain Devices: A Prospective Observational Study.
Article in Cureus, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionDevice-associated central nervous system infections are a subgroup of healthcare-associated infections that occur when either a temporary or permanent surgically implanted device becomes a source of infection. These devices are used to treat raised intracranial pressure due to hydrocephalus. These surgically implanted devices may become a source of infection due to colonization of microbes or contamination from the hospital environment. To determine the diversity of organisms involved in infection using MALDI-TOF-based identification, to assess the antimicrobial profiles of isolated organisms, and to calculate the rate of infection of these devices in our institution, we conducted this study.
methodsThis prospective observational study was conducted over one year at the Departments of Microbiology and Neurosurgery in a tertiary care teaching institute in North India. All patients with cerebrospinal fluid (CSF) drainage devices, such as external ventricular drains (EVDs), ventriculoperitoneal shunts (VPS), Ommaya reservoirs, and lumbar drains, with clinical suspicion of infection in the form of meningitis, meningoencephalitis, or ventriculitis, were included. CSF samples were cultured on 5% sheep blood agar, chocolate agar, and MacConkey agar. Organisms from positive cultures were identified using matrix-assisted laser desorption/ionization time of flight (MALDI-TOF). Antimicrobial susceptibility was determined by the Kirby-Bauer disk diffusion method on Mueller-Hinton agar plates after preparing a 0.5 McFarland inoculum. The results were interpreted as per the Clinical and Laboratory Standards Institute guidelines, M100. Device-associated infection (DAI) rates were calculated monthly.
resultsA total of 107 patients were included. The majority of enrolled patients were men (male-to-female ratio: 1.97:1). Adults comprised 64.5% followed by infants (22.43%) and children (13.08%). Most patients presented with vomiting (41.12%), headache (40.19%), and altered sensorium. VPS was the most commonly used device (65.4%), followed by EVD (30.14%). Among the 231 CSF samples received, 31 from 17 patients showed microbial growth.
conclusionOur study highlights that DAIs are more prevalent with EVDs and are predominantly caused by Gram-negative organisms, with
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