Pattavilakom Ananthababu, Kotasnas Despina, Korman Tony M, Xenos Chris, Danks Andrew
Department of Neurosurgery, Monash Medical Centre, Clayton, Australia.
Neurosurgery. 2006 May;58(5):930-5; discussion 930-5. doi: 10.1227/01.NEU.0000210155.65102.E7.
Shunt infection is a major neurosurgical concern even after 50 years of experience with shunt surgery. Staphylococcus species are responsible for the majority of cerebrospinal fluid shunt infections. In vitro, antibiotic-impregnated cerebrospinal fluid shunt catheters (AIC) have demonstrated protection against multiple staphylococcus species and strains for reasonable periods. We aim to study the longevity of antimicrobial activity of AIC in vivo by using explanted catheters.
Twenty-five AICs (rifampicin [0.054%] and clindamycin [0.15%]) were explanted from 18 patients for noninfectious reasons, from 11 to 700 days postimplantation. The catheters were set up on standardized Staphylococcus aureus culture plates to detect antimicrobial activity. Unused fresh AIC segments were used as control in each culture plates.
Fourteen explanted AICs demonstrated persistent antimicrobial activity against staphylococcal species. Antimicrobial activity was detected for a period of implantation up to 127 days. This is longer than that predicted by in vitro models.
The persistent antimicrobial activity is likely to translate to ongoing in vivo antimicrobial protection. This period of protection exceeds that during which most shunt infections occur.
即使在有50年分流手术经验之后，分流感染仍是神经外科的一个主要问题。葡萄球菌属是大多数脑脊液分流感染的致病菌。在体外，抗生素浸渍脑脊液分流导管（AIC）已证明在合理时间段内可抵御多种葡萄球菌属菌种和菌株。我们旨在通过使用取出的导管来研究AIC在体内抗菌活性的持续时间。
从18例患者中因非感染性原因取出25根AIC（利福平[0.054%]和克林霉素[0.15%]），植入后11至700天。将导管置于标准化金黄色葡萄球菌培养平板上以检测抗菌活性。每个培养平板中使用未使用的新鲜AIC节段作为对照。
14根取出的AIC对葡萄球菌属菌种表现出持续的抗菌活性。在长达127天的植入期内检测到抗菌活性。这比体外模型预测的时间更长。
持续的抗菌活性可能转化为持续的体内抗菌保护。这段保护期超过了大多数分流感染发生的时间段。
