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 the biofilm serves as a barrier that protects the bacteria from antibiotics and host defense mechanisms 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 part of the initial management of device-associated infection examples incision and drainage removal of the infected prosthetic device Medical empiric antibiotic therapy indication part of the initial management of device-associated infection examples vancomycin comments antibiotics are narrowed once the organism is isolated and susceptibility testing is performed Complications Sepsis Prosthetic valve endocarditis Meningitis Exit site signs of infections purulent drainage erythema and swelling