James Hector E, Bradley John S
Lucy Gooding Pediatric Neurosurgery Center, University of Florida Health Sciences Center, Jacksonville, FL 32207, USA.
J Neurosurg Pediatr. 2008 Mar;1(3):223-8. doi: 10.3171/PED/2008/1/3/223.
The authors present their experience with a protocol for the treatment of patients with complicated shunt infections.
Complicated shunt infections are defined for the purpose of this protocol as multiple compartment hydrocephalus, multiple organism shunt infection, severe peritonitis, or infections in other sites of the body. The initial treatment protocol for these patients was 3 weeks of intravenous antibiotic therapy and 2 weeks of twice daily intraventricular/intrashunt antibiotic therapy. Cerebrospinal fluid (CSF) cultures were monitored during therapy and obtained again 48 hours after completion. The shunt was completely replaced. Additionally, follow-up cultures were obtained in all patients 3-6 months after therapy was completed.
A cure of the infection was achieved in all patients as defined by negative cultures obtained at completion of antibiotic therapy and in follow-up studies. The follow-up period was 2-11 years (mean 4.4 +/- 2.5 years). The treatment protocol was modified in the patients treated after 1991, and 18 patients were treated with this modified treatment regime. In these patients, intraventricular antibiotics were administered only once daily for 14 days, and the CSF was cultured 24 hours after antibiotic therapy had been stopped instead of after 48 hours. The results were similar to those obtained with the initial protocol.
Based on their prospective nonrandomized series, the authors believe that patients with complicated shunt infections can be successfully treated with 2 weeks of intraventricular antibiotic therapy administered once daily, concurrent with 3 weeks of intravenous antibiotic therapy. This protocol reduces length of treatment and hospital stay, and avoids recurrence of infection.
作者介绍其治疗复杂性分流感染患者方案的经验。
本方案将复杂性分流感染定义为多腔室脑积水、多种微生物分流感染、严重腹膜炎或身体其他部位感染。这些患者的初始治疗方案为3周静脉抗生素治疗及2周每日两次脑室内/分流管内抗生素治疗。治疗期间监测脑脊液（CSF）培养情况，并在治疗结束后48小时再次采集。分流管完全更换。此外，所有患者在治疗结束后3 - 6个月进行随访培养。
根据抗生素治疗结束时及随访研究中获得的阴性培养结果，所有患者感染均治愈。随访期为2 - 11年（平均4.4±2.5年）。1991年后治疗的患者修改了治疗方案，18例患者采用此修改后的治疗方案。在这些患者中，脑室内抗生素仅每日给药一次，共14天，抗生素治疗停止后24小时而非48小时采集脑脊液培养。结果与初始方案相似。
基于前瞻性非随机系列研究，作者认为复杂性分流感染患者可通过每日一次给予2周脑室内抗生素治疗，并同时进行3周静脉抗生素治疗而成功治愈。该方案缩短了治疗时间和住院时间，并避免了感染复发。
