Fux C A, Quigley M, Worel A M, Post C, Zimmerli S, Ehrlich G, Veeh R H
Center for Biofilm Engineering, Montana State University, Bozeman 59717, USA.
Clin Microbiol Infect. 2006 Apr;12(4):331-7. doi: 10.1111/j.1469-0691.2006.01361.x.
Cerebrospinal fluid (CSF) shunts carry a high risk of complications. Infections represent a major cause of shunt failure. Diagnosis and therapy of such infections are complicated by the formation of bacterial biofilms attached to shunt surfaces. This study correlated the pathophysiology and clinical course of biofilm infections with microscopical findings on the respective shunts. Surface irregularities, an important risk-factor for shunt colonisation with bacteria, were found to increase over time because of silicone degradation. Scanning electron-microscopy (SEM) documented residual biological material (dead biofilm), which can further promote extant bacterial adhesion, on newly manufactured shunts. Clinical course and SEM both documented bacterial dissemination against CSF flow and the monodirectional valve. In all cases, biofilms grew on both the inner and outer surfaces of the shunts. Microscopy and conventional culture detected all bacterial shunt infections. Analyses of 16S rDNA sequences using conserved primers identified bacteria in only one of three cases, probably because of previous formalin fixation of the samples.
脑脊液（CSF）分流术具有较高的并发症风险。感染是分流失败的主要原因。附着在分流装置表面的细菌生物膜的形成使此类感染的诊断和治疗变得复杂。本研究将生物膜感染的病理生理学和临床过程与相应分流装置的显微镜检查结果相关联。表面不规则是细菌在分流装置上定植的一个重要风险因素，由于硅胶降解，其随时间增加。扫描电子显微镜（SEM）记录了新制造的分流装置上存在可进一步促进现存细菌黏附的残留生物物质（死生物膜）。临床过程和SEM均记录了细菌逆脑脊液流动方向和单向瓣膜扩散。在所有病例中，生物膜在分流装置的内表面和外表面均有生长。显微镜检查和传统培养检测到了所有细菌性分流感染。使用保守引物对16S rDNA序列进行分析，仅在三分之一的病例中鉴定出细菌，这可能是因为样本先前经过福尔马林固定。
