Ventricular shunt infections: Immunopathogenesis and clinical management

• Infection often complicates shunt placement, causing long term neurologic problems.
• These infections are caused by biofilms which are antibiotic resistant.
• The immune response to biofilm infection is skewed, allowing bacterial persistence.
• Understanding the neuroimmune response to biofilm is needed to improve outcomes.

Ventricular shunts are the most common neurosurgical procedure performed in the United States. This hydrocephalus treatment is often complicated by infection of the device with biofilm-forming bacteria. In this review, we discuss the pathogenesis of shunt infection, as well as the implications of the biofilm formation on treatment and prevention of these infections. Many questions remain, including the contribution of glia and the impact of inflammation on developmental outcomes following infection. Immune responses within the CNS must be carefully regulated to contain infection while minimizing bystander damage; further study is needed to design optimal treatment strategies for these patients.