Snapshot A 65-year-old man presents to the emergency department with a headache, nausea, and altered mental status. His symptoms developed a few days ago and have since worsened. He was recently diagnosed with normal-pressure hydrocephalus and had placement of a ventriculoperitoneal shunt. Physical examination is notable for diffuse abdominal pain. Direct aspiration of the cerebral spinal fluid shunt is obtained, and CSF analysis demonstrates a leukocytosis, elevated protein, and decreased glucose. CSF Gram stain demonstrates gram-positive cocci in clusters. CSF cultures are pending. Preparations are made for removal of the shunt and he is started on vancomycin and ceftazidime. Introduction Classification gram-positive, catalase-positive, coagulase-negative, urease-positive cocci in clusters novobiocin sensitive Reservoir component of normal skin flora commonly a contaminant Pathogenesis adhesion of the microorganism to the device, leading to colonization extracellular polysaccharide allows for the formation of a protective biofilm on the device login to view 1 more bullet Associated conditions device-associated and healthcare-associated infections e.g., hip implant, heart valve, ventriculoperitoneal shunt, and intravenous catheters Presentation Symptoms/physical exam local signs of infection (e.g., erythema, purulent discharge, and swelling) fever pain at the device site Treatment Conservative source control indication login to view 1 more bullet examples login to view 2 more bullets Medical empiric antibiotic therapy indication login to view 1 more bullet examples login to view 1 more bullet comments login to view 1 more bullet Complications Sepsis Prosthetic valve endocarditis Meningitis Exit site signs of infections purulent drainage erythema and swelling