Effectiveness of single-stage shunt replacement for Cutibacterium acnes CSF shunt infection.

OBJECTIVE

Cutibacterium acnes is a commensal skin and mucosal bacterium that causes CSF shunt infections. The traditional management of C. acnes shunt infections aligns with the treatment of infections caused by more serious bacteria and consists of shunt removal, external ventricular drainage, and systemic antibiotic administration. Given the relatively benign nature of C. acnes, such extensive measures may not be required for infection eradication. This study compares the efficacy of a one-stage surgical shunt replacement, omitting the interim external ventricular drainage phase, with the traditional two-stage approach.

METHODS

A retrospective data analysis was conducted on the medical records of patients diagnosed with C. acnes shunt infection between 1997 and 2023. Clinical and diagnostic data were collected.

RESULTS

Forty-three patients with C. acnes shunt infection were identified. Of these patients, 26 underwent traditional two-stage shunt replacement with intervening external ventricular drainage, and 14 underwent one-stage shunt replacement without an interim external drainage period. Nine patients underwent endoscopic third ventriculostomy in an attempt to achieve shunt independence. C. acnes shunt infection was cleared in all patients with no recurrence at median follow-up periods of 7.08 years and 9.05 years for the one-stage and two-stage replacement groups, respectively.

CONCLUSIONS

The findings indicate that one-stage shunt replacement surgery without intervening externalization is an effective treatment option for C. acnes shunt infections. In addition to eliminating the need for multiple surgical interventions, this approach shortens hospital stays, thereby reducing healthcare costs and minimizing patients' exposure to hospital-associated risks. This study supports a reevaluation of current guidelines for treating shunt infections, advocating for more flexible, patient-centered approaches that consider the pathogenicity of offending organisms such as C. acnes.