Pattavilakom Ananthababu, Xenos Chris, Bradfield Owen, Danks R Andrew
Department of Neurosurgery, Monash Medical Centre, Clayton, Victoria 3168, Australia.
J Clin Neurosci. 2007 Jun;14(6):526-31. doi: 10.1016/j.jocn.2006.11.003.
Antibiotic impregnated shunt catheters have emerged as a promising tool against the continuing challenge of shunt infection. We present our prospective evaluation of the efficacy of antibiotic (rifampicin and clindamycin) impregnated cerebrospinal fluid (CSF) shunt catheters (AIC) in a mixed paediatric and adult Australian population. We have prospectively evaluated all the cerebrospinal fluid shunt procedures carried out in our institution over a 3-year period since July 2002, after the introduction of AIC in our practice. Patient demographics, indication for shunt procedure, risk factors for infection, shunt infections and other relevant factors were documented. The data has been compared with similar data collected over the previous 7 years of our experience with non-antibiotic impregnated catheters for CSF shunt procedures. Pearson's chi-square and Fisher's exact tests are used for statistical evaluation. From July 2002 to June 2005, 243 shunt procedures were carried out using AICs in 178 patients. There were three shunt infections (1.2%). Rigorous retrospective evaluation of shunt procedures over the preceding 7 years revealed 36 infections in 551 shunt procedures (6.5%). This reduction in the infection rate was statistically significant (p=0.0015 on Pearson's chi-square test and p=0.000529 on Fisher's exact test). We also report that the introduction of ceftriaxone prophylaxis during this period was associated with a reduction in Gram-negative shunt infection, but no effect on overall infection rate. We report rifampicin and clindamycin impregnated CSF shunt catheters significantly reduce the rate of shunt infection in Australian clinical practice. This data and the literature support the routine usage of AIC for all CSF shunt procedures.
抗生素浸渍分流导管已成为应对分流感染持续挑战的一种有前景的工具。我们展示了我们对澳大利亚儿科和成人混合人群中抗生素（利福平与克林霉素）浸渍脑脊液（CSF）分流导管（AIC）疗效的前瞻性评估。自2002年7月我们在实践中引入AIC后，我们对本机构在3年期间进行的所有脑脊液分流手术进行了前瞻性评估。记录了患者的人口统计学数据、分流手术指征、感染危险因素、分流感染及其他相关因素。已将这些数据与我们之前7年使用非抗生素浸渍导管进行脑脊液分流手术时收集的类似数据进行比较。采用Pearson卡方检验和Fisher精确检验进行统计学评估。从2002年7月至2005年6月，178例患者使用AIC进行了243次分流手术。发生了3例分流感染（1.2%）。对前7年分流手术进行的严格回顾性评估显示，551次分流手术中有36例感染（6.5%）。感染率的这种降低具有统计学意义（Pearson卡方检验p = 0.0015，Fisher精确检验p = 0.000529）。我们还报告在此期间引入头孢曲松预防与革兰氏阴性菌分流感染的减少相关，但对总体感染率无影响。我们报告利福平与克林霉素浸渍的脑脊液分流导管在澳大利亚临床实践中显著降低了分流感染率。这些数据及文献支持对所有脑脊液分流手术常规使用AIC。
