A 4-year-old child with obstructive hydrocephalus undergoes ventriculoperitoneal (VP) shunt placement. Three months later he presents with fever, headache, vomiting, and abdominal pain. CSF from the shunt reservoir shows WBC 800 (neutrophils 85%), glucose 30 mg/dL (serum 90 mg/dL), protein 180 mg/dL. The MOST common causative organism and appropriate management are:

• A E. coli; IV piperacillin-tazobactam without shunt removal
• B Streptococcus pneumoniae; IV ceftriaxone with dexamethasone, shunt retained
• C Candida albicans; IV amphotericin B with immediate shunt removal
• D Staphylococcus epidermidis; IV vancomycin plus shunt externalisation or removal ✓

Explanation

VP shunt infection most commonly involves coagulase-negative Staphylococci (Staphylococcus epidermidis, ~50–60% of cases) and Staphylococcus aureus, contaminating the shunt at the time of insertion. Management requires IV vancomycin (to cover MRSA/methicillin-resistant coagulase-negative staphylococci) along with externalisation or removal of the infected shunt; antibiotic treatment alone without shunt removal has a very high failure rate for established hardware infections. A new shunt is inserted after CSF sterilisation. E. coli is more common in neonates.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.