Ragel Brian T, Browd Samuel R, Schmidt Richard H
Department of Neurosurgery, University of Utah Health Sciences Center, Salt Lake City, Utah 84132-2303, USA.
J Neurosurg. 2006 Aug;105(2):242-7. doi: 10.3171/jns.2006.105.2.242.
Infection represents the most common serious complication of shunt surgery, and typically its incidence ranges between 5 and 15%, despite the use of systemic antibiotic agents. Because systemic antibiotic medications generally penetrate the cerebrospinal fluid (CSF) poorly, the authors investigated, in a controlled study, whether the addition of intraventricular antibiotic treatment decreases the incidence of perioperative infection in adult patients.
Data pertaining to all CSF shunt procedures conducted at the authors' institution during an 11-year period were reviewed. Perioperative infection was defined as culture-positive CSF and the clinical presence of infection-related symptoms occurring within 90 days of surgery. All patients underwent intraoperative systemic antistaphylococcal antibiotic therapy. Before May 16, 1999, the senior author (R.H.S.) also administered 4 mg of gentamicin intraventricularly at surgery (Group I); thereafter, 10 mg of vancomycin was additionally administered (Group II). Other neurosurgeons at this institution did not use intraventricular antibiotic therapy, and their patients served as additional controls in identical time periods (Groups III and IV). A total of 802 shunt procedures were performed in 534 patients. Control infection rates were 5.4% (eight of 147) in Group I; 6.2% (nine of 145) in Group III; and 6.7% (18 of 267) in Group IV. With the combination of systemic antibiotic and intraventricular gentamicin and vancomycin (Group II), the infection rate fell significantly to 0.4% (one of 243). No complications were noted in association with intraventricular antibiotic administration.
The combination of intraventricular gentamicin and vancomycin with systemic antibiotic therapy significantly decreased the incidence of perioperative shunt infection. It is presumed that intraventricular antibiotic therapy extends prophylactic antibiotic coverage into the CSF and prevents bacterial seeding.
感染是分流手术最常见的严重并发症，尽管使用了全身抗生素，但通常其发生率在5%至15%之间。由于全身抗生素药物通常难以穿透脑脊液（CSF），作者在一项对照研究中调查了术中加用脑室内抗生素治疗是否能降低成年患者围手术期感染的发生率。
回顾了作者所在机构在11年期间进行的所有脑脊液分流手术的数据。围手术期感染定义为脑脊液培养阳性以及在手术后90天内出现与感染相关的临床症状。所有患者均接受术中全身抗葡萄球菌抗生素治疗。1999年5月16日前，资深作者（R.H.S.）还在手术时脑室内给予4mg庆大霉素（第一组）；此后，额外给予10mg万古霉素（第二组）。该机构的其他神经外科医生未使用脑室内抗生素治疗，他们的患者在相同时间段作为额外对照（第三组和第四组）。534例患者共进行了802次分流手术。第一组的对照感染率为5.4%（147例中的8例）；第三组为6.2%（145例中的9例）；第四组为6.7%（267例中的18例）。联合使用全身抗生素以及脑室内庆大霉素和万古霉素（第二组）时，感染率显著降至0.4%（243例中的1例）。未发现与脑室内给予抗生素相关的并发症。
脑室内庆大霉素和万古霉素与全身抗生素治疗联合使用可显著降低围手术期分流感染的发生率。据推测，脑室内抗生素治疗可将预防性抗生素覆盖范围扩展至脑脊液并防止细菌播散。
