Role of c-reactive protein response to antibiotic therapy in children with a ventriculo-peritoneal shunt infection.

Abstract

Hydrocephalus is a common neurosurgical condition in children, with a higher incidence in low and middle-income countries (LMIC). Ventriculoperitoneal (VP) shunt insertion remains the primary treatment, but postoperative infections are a major source of morbidity, leading to repeated surgeries and increased mortality. C-reactive protein (CRP) is a rapid, sensitive marker of inflammation that rises within hours of infection and declines quickly with effective treatment and correlates with bacterial burden. This makes it a practical, low-cost tool for monitoring VP shunt infections and determining the appropriate duration of antibiotic therapy in children. This study aims to evaluate whether CRP trends correlate with clinical improvement and can inform decisions regarding antibiotic treatment length. A total of 147 patients diagnosed with meningitis secondary to a VP shunt infection, from January 2018 to December 2024, were included in this retrospective study conducted at Inkosi Albert Luthuli Central Hospital (IALCH). Clinical presentation, serology results, and culture results were obtained and analysed. Of the 147 children included, more than half were infants (51.7%), presenting with the lowest mean CRP on admission (34.7 mg/L) and congenital hydrocephalus (48.3%). CRP levels were elevated at admission (mean 48.6 mg/L), peaked by day 3-5, and declined gradually to 29.4 mg/L by day 30, with a significant reduction from admission (p = 0.02). Staphylococcus epidermidis (25.9%) and Staphylococcus aureus (21.1%) were the most common organisms, with 58.6% showing antimicrobial resistance. Vancomycin (n = 41; 27.9%) was the most frequently used antibiotic, and mean treatment duration was 27 days, which aligned with a decrease in CRP at day 30. Persistent CRP elevation with no clear infection resolutions was associated with resistant organisms and a complicated infection. CRP is a valuable marker for monitoring treatment response in paediatric VP shunt infections, showcasing a decline with clinical improvement. However, its variability, particularly in infants and resistant infections, limits its use as the sole guide for antibiotic duration. The integration of CRP with clinical indicators, microbiological data, and shunt-related decision-making enhances therapy and supports better paediatric outcomes.