Thompson Dominic N P, Hartley John C, Hayward Richard D
Department of Neurosurgery, Great Ormond Street Hospital for Children, NHS Trust, London, United Kingdom.
J Neurosurg. 2007 Jan;106(1 Suppl):15-9. doi: 10.3171/ped.2007.106.1.15.
The aim of this study was to establish whether microbiological contamination at the time of shunt insertion can be detected and used to predict the likelihood of subsequent shunt infection.
A prospective study of pediatric patients undergoing primary shunt insertion was undertaken. Following the protocol devised for this study, three swab samples were collected from the surgical wounds during each procedure. These samples were incubated and subcultured, and the isolates were identified and stored. In patients who subsequently presented with clinical evidence of shunt infection, cerebrospinal fluid (CSF) was analyzed using microscopy, tissue cultures, and sensitivity testing. The organisms isolated at the time of shunt insertion and those responsible for subsequent shunt infection were then compared. The study population consisted of 107 pediatric patients. Because one patient underwent placement of an additional contralateral shunt system, there were 108 total shunt insertions yielding 325 swab samples. Organisms were identified in cultures of 50 swab samples (15%) obtained in 40 patients (37%). In seven of these 40 patients (17.5%) a CSF infection subsequently developed. In only one patient was the infectious organism the same as that isolated from the swab specimens. In an additional six patients (8.8%) a CSF infection occurred despite the lack of growth in the cultures from intraoperative swab samples.
The organisms responsible for shunt infection were rarely detected in the operative wound at the time of shunt insertion, leading the authors to conclude that the vulnerable period for bacterial colonization of shunts may not be restricted to the operative procedure as is commonly believed, but may extend throughout the postoperative period of wound healing. These findings have implications not only for a better understanding of the cause of shunt infections but also for the development of strategies to prevent them.
本研究的目的是确定在分流器植入时是否能检测到微生物污染，并利用其预测随后发生分流器感染的可能性。
对接受初次分流器植入的儿科患者进行了一项前瞻性研究。按照本研究设计的方案，在每次手术过程中从手术伤口采集三份拭子样本。这些样本进行培养和传代培养，分离出的菌株进行鉴定和保存。对于随后出现分流器感染临床证据的患者，使用显微镜检查、组织培养和药敏试验对脑脊液（CSF）进行分析。然后比较分流器植入时分离出的微生物与导致随后分流器感染的微生物。研究人群包括107名儿科患者。由于一名患者接受了额外的对侧分流系统植入，总共进行了108次分流器植入，获得了325份拭子样本。在40名患者（37%）采集的50份拭子样本（15%）培养物中鉴定出了微生物。在这40名患者中的7名（17.5%）随后发生了脑脊液感染。只有一名患者的感染性微生物与从拭子标本中分离出的相同。另外6名患者（8.8%）尽管术中拭子样本培养无生长，但仍发生了脑脊液感染。
在分流器植入时，导致分流器感染的微生物很少在手术伤口中被检测到，这使得作者得出结论，分流器细菌定植的易感染期可能不像通常认为的那样仅限于手术过程，而是可能贯穿伤口愈合的整个术后时期。这些发现不仅对更好地理解分流器感染的原因有意义，而且对预防分流器感染策略的制定也有意义。
