Govender Soma T, Nathoo Narendra, van Dellen James R
Department of Neurosurgery, Wentworth Hospital, Nelson R. Mandela School of Medicine, University of Natal, Durban, South Africa.
J Neurosurg. 2003 Nov;99(5):831-9. doi: 10.3171/jns.2003.99.5.0831.
Staphylococcus species are the most common organisms responsible for infection following implantable cerebrospinal fluid (CSF) diversionary procedures. The role of an antibiotic-impregnated shunt (AIS) system in the prevention of shunt infection has remained unclear because no human clinical trial has been reported on thus far. In this study, the authors assess an AIS system with respect to its prevention of shunt infection.
Patients were prospectively randomized into groups to evaluate the efficacy of an AIS system against an identical control shunt system. The data accrued were subjected to a detailed statistical analysis. Logistic regression analysis was performed to determine the independent association between outcome and predictor variables. Shunt function analysis was also performed to compare the average time to infection between the two groups. One hundred ten patients were recruited; 60 received control shunt systems and 50 received AIS systems. Thirteen shunt infections were recorded (10 in the control group and three in the AIS group). Nine (69%) of 13 infections occurred within 2 months after shunt implantation (eight of 10 in the control group and one of three in the AIS group). Apart from one patient in whom no organism was identified, a total of 14 organisms (12 patients) were cultured from either the CSF (nine) or the shunt apparatus (three). Staphylococcus species accounted for the majority of shunt infections (83%): all 10 control shunts were found to have a positive culture of staphylococci, whereas none of the AISs had any staphylococci (p = 0.038).
The AIS afforded antistaphylococcal protection, especially during the early postoperative period when most shunt infections are known to occur and throughout the follow-up period (median 9 months). The AIS system represents another important tool to enable the neurosurgeon to prevent shunt infections.
葡萄球菌属是植入式脑脊液（CSF）分流术后感染最常见的病原体。抗生素浸渍分流（AIS）系统在预防分流感染中的作用仍不明确，因为迄今为止尚无人体临床试验报告。在本研究中，作者评估了AIS系统预防分流感染的效果。
将患者前瞻性随机分组，以评估AIS系统相对于相同对照分流系统的疗效。对收集到的数据进行详细的统计分析。进行逻辑回归分析以确定结果与预测变量之间的独立关联。还进行了分流功能分析，以比较两组之间的平均感染时间。招募了110名患者；60名接受对照分流系统，50名接受AIS系统。记录了13例分流感染（对照组10例，AIS组3例）。13例感染中有9例（69%）发生在分流植入后2个月内（对照组10例中的8例，AIS组3例中的1例）。除1例未鉴定出病原体的患者外，共从脑脊液（9例）或分流装置（3例）中培养出14种病原体（12例患者）。葡萄球菌属占分流感染的大多数（83%）：所有10个对照分流均培养出葡萄球菌阳性，而AIS均未培养出葡萄球菌（p = 0.038）。
AIS提供了抗葡萄球菌保护，尤其是在已知大多数分流感染发生的术后早期以及整个随访期（中位时间9个月）。AIS系统是神经外科医生预防分流感染的另一个重要工具。
