Ratilal B, Costa J, Sampaio C
Hospital de São José, Department of Neurosurgery, Rua José António Serrano, Lisboa, Portugal 1150-199.
Cochrane Database Syst Rev. 2006 Jul 19;2006(3):CD005365. doi: 10.1002/14651858.CD005365.pub2.
Systemic antibiotics and antibiotic-impregnated shunt systems are often used to prevent shunt infection.
To evaluate the effectiveness of either prophylactic systemic antibiotics or antibiotic-impregnated shunt systems for preventing infection in patients who underwent surgical introduction of intracranial ventricular shunts.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, LILACS and the meeting proceedings from the American Association of Neurological Surgeons and from the European Association of Neurosurgical Societies, until June 2005.
We included randomized or quasi-randomized controlled trials comparing the use of prophylactic antibiotics (either systemic or antibiotic-impregnated shunt systems) in intracranial ventricular shunt procedures with placebo or no antibiotics.
Two authors appraised quality and extracted data independently.
We included seventeen trials with overall 2134 participants. We performed two separate meta-analyses: one that evaluated the use of systemic prophylactic antibiotics and another that evaluated the use of antibiotic-impregnated systems. All studies included shunt infection in their primary outcome. We could not analyse all-cause mortality regarding systemic antibiotics due to lack of data. No significant differences were found (odds ratio (OR): 1.47, 95% confidence intervals (CI) 0.83 to 2.62) for this outcome regarding the use of antibiotic-impregnated catheters compared with standard ones. The use of systemic antibiotic prophylaxis and the use of antibiotic-impregnated catheters were associated with a decrease in shunt infection (OR: 0.52, 95% CI 0.36 to 0.74 and OR: 0.21, 95% CI 0.08 to 0.55 respectively). We found no significant benefit for shunt revision in both meta-analyses that evaluated systemic antibiotics and impregnated-shunt systems. We found no significant differences between the subgroups evaluated: type of shunt (internal/external, ventriculoperitoneal/ventriculoatrial), age and duration of the administration of antibiotics.
AUTHORS' CONCLUSIONS: We could demonstrate a benefit of systemic prophylactic antibiotics for the first 24 hours postoperatively to prevent shunt infection, regardless of the patient's age and the type of internal shunt used. The benefit of its use after this period remains uncertain. However this data derives from the rate of shunt infection, which is an intermediary outcome. Future trials should evaluate the effectiveness of different regimens of systemic antibiotics rather than placebo, and should include all-cause mortality, shunt revision and adverse events as additional outcomes. Evidence suggests that antibiotic-impregnated catheters reduce the incidence of shunt infection although more well-designed clinical trials testing the effect of antibiotic-impregnated shunts are required to confirm their net benefit.
全身应用抗生素及抗生素浸渍分流系统常用于预防分流感染。
评估预防性全身应用抗生素或抗生素浸渍分流系统对接受颅内脑室分流手术患者预防感染的有效性。
我们检索了Cochrane对照试验中心注册库（CENTRAL）、MEDLINE、EMBASE、拉丁美洲和加勒比卫生科学数据库（LILACS）以及美国神经外科医师协会和欧洲神经外科学会的会议论文集，检索截至2005年6月。
我们纳入了随机或半随机对照试验，这些试验比较了在颅内脑室分流手术中使用预防性抗生素（全身应用或抗生素浸渍分流系统）与使用安慰剂或不使用抗生素的情况。
两位作者独立评估质量并提取数据。
我们纳入了17项试验，共有2134名参与者。我们进行了两项单独的荟萃分析：一项评估全身预防性抗生素的使用，另一项评估抗生素浸渍系统的使用。所有研究均将分流感染作为主要结局。由于缺乏数据，我们无法分析全身应用抗生素的全因死亡率。与标准导管相比，在该结局方面，使用抗生素浸渍导管未发现显著差异（优势比（OR）：1.47，95%置信区间（CI）0.83至2.62）。全身应用抗生素预防和使用抗生素浸渍导管均与分流感染的减少相关（OR分别为：0.52，95%CI 0.36至0.74和OR：0.21，95%CI 0.08至0.55）。在评估全身应用抗生素和浸渍分流系统的两项荟萃分析中，我们均未发现分流修正有显著益处。我们在评估的亚组之间未发现显著差异：分流类型（内/外，脑室-腹腔/脑室-心房）、年龄和抗生素给药持续时间。
我们可以证明术后最初24小时全身预防性应用抗生素对预防分流感染有益，无论患者年龄和所使用的内部分流类型如何。在此之后使用抗生素的益处仍不确定。然而，这些数据来自分流感染率，这是一个中间结局。未来的试验应评估不同方案的全身应用抗生素而非安慰剂的有效性，并应将全因死亡率、分流修正和不良事件作为额外结局。有证据表明抗生素浸渍导管可降低分流感染的发生率，尽管需要更多设计良好的临床试验来测试抗生素浸渍分流的效果以确认其净益处。
