If shunt infection is suspected, which two emergency management steps are appropriate?

• A. Initiate empiric antibiotics after obtaining CSF if safe; consult neurosurgery
• B. Schedule elective revision
• C. Observe without antibiotics
• D. Start antifungal therapy

Answer: (A)

In suspected shunt infection, the priority is rapid infection control and source management. The first step is to obtain CSF for culture if it can be done safely, then start empiric IV antibiotics promptly to cover the common organisms. At the same time, involve neurosurgery urgently because infected shunts typically require externalization or removal and then re-implantation after the infection is cleared. Delaying antibiotics or opting for observation isn’t appropriate in this emergency situation, and antifungal therapy isn’t started unless there’s evidence of a fungal infection or a high risk for it.