Ratilal Bernardo, Costa João, Sampaio Cristina
Department of Neurosurgery, Hospital São José, Lisboa, Portugal.
J Neurosurg Pediatr. 2008 Jan;1(1):48-56. doi: 10.3171/PED-08/01/048.
Systemic antibiotics and antibiotic-impregnated shunt (AIS) systems are often used to prevent shunt infection. The authors conducted a systematic review to evaluate its effectiveness of antibiotics in patients who underwent placement of intracranial ventricular shunts.
The authors searched the Cochrane Central Register of Controlled Trials, 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. Randomized and quasi-randomized trials comparing the use of prophylactic antibiotics (either systemic or AIS systems) in intracranial ventricular shunt procedures with placebo or no antibiotics were included in the review.
Seventeen trials involving 2134 patients were included. Results from the meta-analysis showed that the use of systemic antibiotic prophylaxis for internal shunts was associated with a decrease in shunt infection (odds ratio 0.51; 95% confidence interval 0.36-0.73). The authors found no significant differences between the subgroups evaluated in type of internal shunt (ventriculoperitoneal/ventriculoatrial), age, or duration of the administration of antibiotics.
The authors found a benefit of systemic prophylactic antibiotics in preventing shunt infection, regardless of the patient's age and the type of internal shunt used. The benefit of its use after the first 24 hours postoperatively remains uncertain. Future trials should be conducted to evaluate the effectiveness of different regimens of systemic antibiotics rather than placebo, namely single preoperative dose versus multiple doses. It should also be mandatory to evaluate the effectiveness of systemic prophylactic antibiotics for external ventricular drains. Evidence suggests that antibiotic-impregnated catheters reduce the incidence of shunt infection, although more well-designed clinical trials are needed.
全身使用抗生素及抗生素浸渍分流管（AIS）系统常用于预防分流感染。作者进行了一项系统评价，以评估抗生素在接受颅内脑室分流术患者中的有效性。
作者检索了Cochrane对照试验中央注册库、MEDLINE、EMBASE、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。本评价纳入了比较在颅内脑室分流手术中使用预防性抗生素（全身使用或AIS系统）与安慰剂或不使用抗生素的随机和半随机试验。
纳入了17项涉及2134例患者的试验。荟萃分析结果显示，全身预防性使用抗生素治疗内部分流与分流感染的减少相关（比值比0.51；95%置信区间0.36 - 0.73）。作者发现，在内部分流类型（脑室 - 腹腔/脑室 - 心房）、年龄或抗生素给药持续时间方面评估的亚组之间没有显著差异。
作者发现全身预防性使用抗生素在预防分流感染方面有益，无论患者年龄和所使用的内部分流类型如何。术后24小时后使用抗生素的益处仍不确定。未来应进行试验以评估不同全身抗生素方案而非安慰剂的有效性，即术前单次剂量与多次剂量。还应强制评估全身预防性抗生素对外引流管的有效性。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。
