Cerebrospinal Fluid System Infection in Children with Cancer: A Retrospective Analysis over 14 Years in a Major European Pediatric Cancer Center

Abstract

Infection of a cerebrospinal fluid system is a serious medical complication. We performed a retrospective monocentric analysis on temporary and permanent cerebrospinal fluid devices in children with and without cancer, covering a period of over 14 years. Between 2004 and 2017, 275 children with a cerebrospinal fluid system were seen at our institution. Thirty-eight children suffered from 51 microbiologically proven infectious episodes of the cerebrospinal fluid system (12 children with cancer and 26 children without cancer). Independently of the cerebrospinal fluid system used, the incidence of infection did not significantly differ between children with and without cancer and was the highest in children younger than one year. Infection occurred earlier in external ventricular drain (EVD) than ventriculoperitoneal (VP) shunt, and in EVD significantly earlier in children with cancer compared with patients without cancer. The pathogens isolated were mainly Gram-positive bacteria, in particular Staphylococcus spp., which should be taken into account for empirical antimicrobial therapy.

Keywords: cancer; cerebrospinal fluid system; child; hydrocephalus; infection.

Figure 1

Flowchart of patient selection. * age older 18 years, transfered to another institution during therapy, or insufficient clinical data.

Figure 2

Overview of children with infection of a liquor draining system. EVD, external ventricular drain; VP, ventriculoperitoneal; VA, ventriculoatrial.

Figure 3

Underlying diseases in infected cerebrospinal fluid systems (EDV on the left (n = 22), other cerebrospinal fluid systems on the right (n = 39)). EVD external ventricular drain; IVH intraventricular hemorrhage.

Figure 4

Overview of children without infection. EVD, external ventricular drain; VP, ventriculo-peritoneal.

Figure 5

Overview of episodes of cerebrospinal fluid system infection. EVD, external ventricular drain; VP, ventriculoperitoneal; VA, ventriculoatrial.

Figure 6

Resistance rates (in vitro) of Staphylococcus spp. isolated in children with cerebrospinal shunt systems against the most commonly used antibiotics in percentage, in general and for children with cancer (“onco*”) specifically.