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6149441 
Journal Article 
Biofilm-related infections of cerebrospinal fluid shunts 
Fux, CA; Quigley, M; Worel, AM; Post, C; Zimmerli, S; Ehrlich, G; Veeh, RH 
2006 
Yes 
Clinical Microbiology and Infection
ISSN: 1198-743X
EISSN: 1469-0691 
12 
4 
331-337 
English 
16524409 
WOS:000235661400006 
Cerebrospinal fluid (CSF) shunts carry a high risk of complications. Infections represent a major cause of shunt failure. Diagnosis and therapy of such infections are complicated by the formation of bacterial biofilms attached to shunt surfaces. This study correlated the pathophysiology and clinical course of biofilm infections with microscopical findings on the respective shunts. Surface irregularities, an important risk-factor for shunt colonisation with bacteria, were found to increase over time because of silicone degradation. Scanning electron-microscopy (SEM) documented residual biological material (dead biofilm), which can further promote extant bacterial adhesion, on newly manufactured shunts. Clinical course and SEM both documented bacterial dissemination against CSF flow and the monodirectional valve. In all cases, biofilms grew on both the inner and outer surfaces of the shunts. Microscopy and conventional culture detected all bacterial shunt infections. Analyses of 16S rDNA sequences using conserved primers identified bacteria in only one of three cases, probably because of previous formalin fixation of the samples. 
biofilm; cerebrospinal fluid shunts; colonisation; electron-microscopy; pathogenesis; shunt infections; pathogenesis