对分流感染零容忍：能否实现？
Zero tolerance to shunt infections: can it be achieved?
作者信息
Choksey M S, Malik I A
机构信息
Department of Neurosurgery, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK.
出版信息
J Neurol Neurosurg Psychiatry. 2004 Jan;75(1):87-91.
Abstract
OBJECTIVE
To evaluate the rigid application of a technique of shunt placement aimed at the eradication of postoperative shunt infection in neurosurgical practice.
METHOD
All shunt procedures were performed or closely supervised by the senior author (MSC). The essentials were the use of intravenous peri- and postoperative antimicrobials, rigid adherence to classical aseptic technique, liberal use of topical antiseptic (Betadine), and avoidance of haematomas.
RESULTS
Of 176 operations, 93 were primary procedures; 33 patients underwent revisions, some multiple. Only one infection occurred, seven months postoperatively, secondary to appendicitis with peritonitis. The infecting Streptococcus faecalis appeared to ascend from the abdominal cavity.
CONCLUSION
A rigidly applied protocol and strict adherence to sterile technique can reduce shunt infections to a very low level.
摘要
目的
评估在神经外科实践中严格应用旨在根除术后分流感染的分流置入技术。
方法
所有分流手术均由资深作者（MSC）实施或密切监督。要点包括围手术期及术后静脉使用抗菌药物、严格遵守经典无菌技术、大量使用局部防腐剂（碘伏）以及避免血肿形成。
结果
176例手术中，93例为初次手术；33例患者接受了翻修手术，部分患者多次翻修。仅发生1例感染，于术后7个月出现，继发于阑尾炎伴腹膜炎。感染的粪肠球菌似乎是从腹腔上行感染的。
结论
严格应用方案并严格遵守无菌技术可将分流感染率降至极低水平。
相似文献
1
Zero tolerance to shunt infections: can it be achieved?
J Neurol Neurosurg Psychiatry. 2004 Jan;75(1):87-91.
2
Sterile surgical technique for shunt placement reduces the shunt infection rate in children: preliminary analysis of a prospective protocol in 115 consecutive procedures.
Childs Nerv Syst. 2007 Nov;23(11):1251-61. doi: 10.1007/s00381-007-0415-5. Epub 2007 Aug 18.
3
Reduction in CSF shunt infection over a 10-year period associated with the application of concentrated topical antibiotic powder directly to surgical wounds prior to closure.
J Neurosurg Pediatr. 2015 Dec;16(6):648-61. doi: 10.3171/2014.12.PEDS13675. Epub 2015 Sep 18.
4
Effect of an intraoperative double-gloving strategy on the incidence of cerebrospinal fluid shunt infection.
J Neurosurg. 2006 Jan;104(1 Suppl):5-8. doi: 10.3171/ped.2006.104.1.5.
5
Antimicrobial suture wound closure for cerebrospinal fluid shunt surgery: a prospective, double-blinded, randomized controlled trial.
J Neurosurg Pediatr. 2008 Aug;2(2):111-7. doi: 10.3171/PED/2008/2/8/111.
6
Complications associated with bacitracin powder in surgical wounds.
J Neurosurg Pediatr. 2015 Dec;16(6):719-25. doi: 10.3171/2015.4.PEDS14699. Epub 2015 Sep 18.
7
Infections in neurosurgery: a retrospective study of 1143 patients and 1517 operations.
Acta Neurochir (Wien). 1985;78(3-4):81-90. doi: 10.1007/BF01808684.
8
Pediatric neurosurgical practice patterns designed to prevent cerebrospinal fluid shunt infection.
Pediatr Neurosurg. 2009;45(6):456-60. doi: 10.1159/000277621. Epub 2010 Jan 26.
9
Infection of cerebrospinal fluid shunts in infants: a study of etiological factors.
J Neurosurg. 1992 Jul;77(1):29-36. doi: 10.3171/jns.1992.77.1.0029.
10
CSF shunt infections in children: experiences from a population-based study.
Acta Neurochir (Wien). 2003 Apr;145(4):243-8; discussion 248. doi: 10.1007/s00701-002-1068-5.
引用本文的文献
1
A Rare Complication of Proteus Brain Abscess Due to Coccidioidomycosis Causing Hydrocephalus.
J Investig Med High Impact Case Rep. 2024 Jan-Dec;12:23247096241274340. doi: 10.1177/23247096241274340.
2
Ventriculoperitoneal shunt failures at Red Cross War Memorial Children's Hospital.
Childs Nerv Syst. 2024 Sep;40(9):2871-2881. doi: 10.1007/s00381-024-06466-w. Epub 2024 May 23.
3
Practical Guidance for Clinical Microbiology Laboratories: Microbiologic diagnosis of implant-associated infections.
Clin Microbiol Rev. 2024 Jun 13;37(2):e0010423. doi: 10.1128/cmr.00104-23. Epub 2024 Mar 20.
4
Clinical features and risk factors of surgical site infections in HIV-negative patients with cryptococcal meningitis underwent ventriculoperitoneal shunt operations: a retrospective study.
BMC Infect Dis. 2022 Sep 14;22(1):736. doi: 10.1186/s12879-022-07719-2.
5
Challenges in the Management of Gram-Negative Bacterial Infections in Patients With Ventriculoperitoneal Shunt.
Cureus. 2021 Aug 9;13(8):e17035. doi: 10.7759/cureus.17035. eCollection 2021 Aug.
6
[Placement of ventricle peritoneal shunt in the adult patient. A new protocol].
Surg Neurol Int. 2019 Aug 2;10(Suppl 1):S26-S36. doi: 10.25259/SNI_159_2019. eCollection 2019.
7
Effect of introduction of a standardised peri-operative protocol on CSF shunt infection rate: a single-centre cohort study of 809 procedures.
Childs Nerv Syst. 2018 Dec;34(12):2407-2414. doi: 10.1007/s00381-018-3953-0. Epub 2018 Aug 21.
8
Central Nervous System Device Infections.
Curr Infect Dis Rep. 2016 Nov;18(11):34. doi: 10.1007/s11908-016-0541-x.
9
Hydrogel-coated ventricular catheters for high-risk patients receiving ventricular peritoneum shunt.
Medicine (Baltimore). 2016 Jul;95(29):e4252. doi: 10.1097/MD.0000000000004252.
10
Outcome of ventriculoperitoneal shunt and predictors of shunt revision in infants with posthemorrhagic hydrocephalus.
Childs Nerv Syst. 2016 Aug;32(8):1405-14. doi: 10.1007/s00381-016-3090-6. Epub 2016 Jun 9.
本文引用的文献
1
CSF shunt infections in children.
Infection. 1993 Mar-Apr;21(2):89-92. doi: 10.1007/BF01710738.
2
A survey of the first complication of newly implanted CSF shunt devices for the treatment of nontumoral hydrocephalus. Cooperative survey of the 1991-1992 Education Committee of the ISPN.
Childs Nerv Syst. 1994 Jul;10(5):321-7. doi: 10.1007/BF00335171.
3
Hydrocephalus shunt infections.
J Antimicrob Chemother. 1994 Aug;34 Suppl A:75-84. doi: 10.1093/jac/34.suppl_a.75.
4
Complications of ventriculoatrial and ventriculoperitoneal shunts in a new children's hospital.
Can J Surg. 1980 Nov;23(6):566-8.
5
Results of treatment with ventriculoatrial and ventriculoperitoneal shunt in infantile nontumoral hydrocephalus.
Childs Brain. 1980;7(1):1-14. doi: 10.1159/000119545.
6
Neurosurgical shunt infections. A review.
Childs Brain. 1980;6(2):74-81. doi: 10.1159/000119888.
7
Cerebrospinal fluid shunts interfere with host defenses.
Neurosurgery. 1982 Jan;10(1):55-60.
8
Prophylactic methicillin for shunt operations: effects on incidence of shunt malfunction and infection.
Childs Brain. 1982;9(1):10-22. doi: 10.1159/000120031.
9
Effect of prophylactic methicillin on cerebrospinal fluid shunt infections in children.
Neurosurgery. 1981 Jul;9(1):6-8. doi: 10.1227/00006123-198107000-00002.
10
Antibiotic prophylaxis in ventricular shunt surgery. I. Reduction of operative infection rates with methicillin.
Childs Brain. 1980;7(4):182-9.
Zotero 插件