Shunt Infection: Symptoms, Treatment, and Recovery

Shunt Infection: What Patients and Families Should Know

An infection of a shunt is a serious complication that can occur in individuals with hydrocephalus who rely on a shunt to manage cerebrospinal fluid (CSF) flow. Because the shunt connects the brain (or spinal fluid space) to another part of the body, bacteria that cause an infection of the shunt can sometimes enter those areas and cause infection.

Shunt infections can happen to anyone with a shunt, often showing up in the first few months after a shunt surgery. While serious, they are treatable. With early recognition and proper care, most people recover fully and return to their routines.

What Causes a Shunt Infection?

Shunt infections can occur when bacteria enter the body during or after surgery. This may happen through:

• Skin bacteria entering through the shunt surgery incisions, at the time of surgery or as the incision is healing. This can occur even when sterile precautions are followed during surgery.
• Spread from another infection elsewhere in the body (though less common).

Most infections develop within the first few months after surgery, but they can occur later. Knowing when infections are most likely helps families stay alert during higher-risk periods.

Does the Type of Shunt Affect Infection Presentation?

Yes. The location where a shunt drains CSF can affect how and what symptoms appear.  Any shunt that is infected can show symptoms just like a shunt blockage or obstruction.  Other ways a shunt can show signs of an infection are more specific to the type of shunt:

• Ventriculoperitoneal (VP) shunts (the most common shunt type) drain fluid into the abdomen. Infections may cause abdominal pain, tenderness, or fluid building up in the belly.
• Ventriculoatrial (VA) shunts drain fluid into a vein leading to the heart. Because these shunts connect directly to the bloodstream, an infection can spread quickly and cause bloodstream infections (bacteremia or sepsis). These infections are serious and require immediate medical treatment.
• Ventriculopleural (VPL) shunts drain into the chest cavity. Infections may cause coughing, chest discomfort, or shortness of breath.
• Lumboperitoneal (LP) shunts take the spinal fluid from the lower spine and drain into the abdomen. These infections can cause lower back pain (where the shunt starts), the same symptoms as shunts that drain to the belly or symptoms related to infection of the spinal fluid (headache, meningitis).

Your neurosurgeon will work to define any infection and will monitor for signs of infection related to its placement site.

Shunt Infection Symptoms to Watch For

Symptoms vary depending on age, the type of shunt, and the severity of the infection. Some develop gradually; others appear suddenly.

Common symptoms include:

• Redness or Swelling: Tenderness, warmth, or redness along the shunt tract or incision site.
• Headache: Worsening or different from usual hydrocephalus headaches.
• Nausea and Vomiting: Sometimes accompanied by poor appetite.
• Changes in Thinking or Behavior: Confusion, drowsiness, or difficulty concentrating.
• Fever: Persistent or recurring, not relieved by fever reducers.
• Fatigue or Irritability: Children may seem cranky; adults may feel unusually tired.
• Fluid Accumulation: Swelling around the head, neck, or abdomen if the shunt isn’t draining properly.

In infants: a bulging soft spot (fontanelle), high-pitched cry, or poor feeding may occur as the shunt may not work well.

If you notice any of these signs, contact your neurosurgeon immediately or go to the nearest emergency department.

If your neurosurgeon is unavailable, ask for the on-call neurosurgery team. Do not wait for symptoms to worsen.

For a full list of warning signs, visit Signs and Symptoms of a Shunt Complication.

How Doctors Diagnose a Shunt Infection

Diagnosis usually involves several steps:

1. Clinical Examination: Relating your symptoms and neurological status to the type of shunt, checking incision sites.
2. Culturing any fluid coming from a wound.
3. Cerebrospinal Fluid (CSF) Testing: A sample is taken from the shunt or spine to check for infection.
4. Blood Tests: Detect infection or inflammation.
5. Imaging Tests: CT scan, MRI, or X-ray to look for shunt blockages or disconnections.

Because infections can resemble shunt malfunctions, accurate diagnosis is critical.

Learn more about Tests to Assess a Shunt Malfunction or Failure.

How a Shunt Infection Is Treated

Treating a shunt infection almost always requires surgery along with antibiotics. Bacteria can form a coating (biofilm) on or in the shunt tubing, which prevents antibiotics from getting to the bacteria.

Treatment typically includes:

• Surgical Removal of the Infected Shunt: The neurosurgeon removes the infected shunt to stop the infection from spreading and remove the bacteria that are stuck on the shunt.
• Placement of a Temporary External Ventricular Drain (EVD): Continued drainage of spinal fluid is still needed, so a temporary EVD is placed to safely drain CSF while the infection is treated.
• IV Antibiotics: Given for several days to weeks, depending on the bacteria found and how your body responds to the treatment.
• Replacement of the EVD: This is sometimes needed if the infection does not clear up promptly, and the EVD becomes contaminated with bacteria.
• Surgical Placement of a New Shunt: Once the infection is treated and the tests suggest the infection has been cleared, a new shunt is surgically implanted.

This multi-step process ensures the infection is fully treated and CSF flow is restored safely.

Recovery After a Shunt Infection

Treatment can take time and often includes multiple surgeries and a hospital stay.

1. Multiple Surgeries: At least two are needed—one to remove the infected shunt and place the drain, and another to implant a new shunt. Sometimes the temporary EVD needs to be replaced.
2. Hospitalization: You or your loved one will stay in the hospital while the infection clears and drainage is monitored.
3. Follow-Up Care: Regular appointments help ensure the new shunt works properly and no infection returns.
4. Caregiving at Home: Caregivers may help with wound care, medications, and monitoring for fever or swelling. Ask your care team for written instructions and direct phone numbers.
5. Emotional and Physical Healing: It’s normal to feel anxious or tired after several surgeries. Support from healthcare providers, family, and peers can make recovery easier.

How to Prevent Shunt Infections

Not all infections can be prevented, but these steps can reduce risk:

• Practice Good Hygiene: Keep incision sites clean and dry. Follow your neurosurgery team’s recommendations for post operative wound care.
• Watch for Early Symptoms: Report any new or unusual symptoms promptly.
• Keep Regular Follow-Ups: Routine checkups help doctors monitor healing and shunt function.
• Stay Informed: Knowing what to expect empowers families to act quickly if problems arise.

Finding Support During and After Recovery

A shunt infection can be overwhelming, but you’re not alone. Our Community Networks and peer program, HydrocephalusCONNECT, connect you with others who have been through this experience. Sharing stories and advice can make the journey less isolating and more hopeful.

Living Well After a Shunt Infection

A shunt infection is a serious but treatable event. With early recognition, timely surgery, and strong follow-up care, most individuals recover and return to normal life.

By maintaining open communication with your healthcare team, staying alert to symptoms, and connecting with supportive peers, you can face complications with confidence and hope.

Information you can trust! This article was produced by the Hydrocephalus Association, copyright 2025. We would like to thank Bruce A. Kaufman, MD for his valuable contribution and expert input.

This article is designed to provide helpful information on the subjects discussed. It is not intended as a substitute for treatment advice from a medical professional. For diagnosis or treatment of any medical condition, consult your doctor.