Parker Scott L, Attenello Frank J, Sciubba Daniel M, Garces-Ambrossi Giannina L, Ahn Edward, Weingart Jon, Carson Benjamin, Jallo George I
Department of Neurosurgery, The Johns Hopkins Hospital, 600 N. Wolfe Street, Harvey 811, Baltimore, MD 21287, USA.
Childs Nerv Syst. 2009 Jan;25(1):77-83; discussion 85. doi: 10.1007/s00381-008-0743-0. Epub 2008 Nov 5.
Shunt infection is a morbid complication of CSF shunting. Though antibiotic-impregnated shunt (AIS) systems decrease shunt infections by preventing bacterial colonization following device implantation, their effectiveness in populations at high risk for infection has recently been disputed. We set out to determine whether the categorical switch to AIS systems at our institution has resulted in a decreased incidence of shunt infection in high-risk pediatric patients.
We retrospectively reviewed the records from all pediatric patients undergoing CSF shunt procedures at The Johns Hopkins Hospital over a 10-year period between January 1997 and December 2007. During the 5.75 years prior to October 2002, all CSF shunts included standard, non-AIS catheters. During the 4.25 years after October 2002, all CSF shunts included AIS catheters. High-risk subgroups were defined a priori as prematurity (<35 weeks gestational age), shunts placed immediately post-meningitis, conversion of external ventricular drains (EVD) to shunt, and replacement of nosocomial shunt infection in patients requiring prolonged hospital stay (>1 month).
A total of 544 pediatric patients underwent 1,072 shunt placement procedures (502 AIS, 570 non-AIS). Of patients with non-AIS catheters, 64 (11.2%) experienced shunt infection, whereas only 16 (3.2%) patients with AIS catheters experienced shunt infection (p<0.001). AIS versus non-AIS was associated with decreased shunt infection in premature neonates [three (5.5%) vs. seven (20.0%), p=0.030], acutely following bacterial meningitis [two (5.7%) vs. nine (25.0%), p=0.043], when converting EVD to shunts [zero (0%) vs. four (13.3%), p=0.030], and in patients with prolonged hospital stay>1 month [three (5.3%) vs. 12 (18.5%), p=0.022]. Staphylococcus aureus was the most common infectious agent for both non-AIS (81.3%) and AIS (75.0%) systems.
The introduction of AIS catheters into our institutional practice has reduced the incidence of shunt infection in pediatric populations at highest risk for infection. AIS catheters are effective instruments to prevent peri-operative colonization of CSF shunt components.
分流感染是脑脊液分流术的一种严重并发症。尽管抗生素浸渍分流（AIS）系统通过防止装置植入后细菌定植来降低分流感染率，但其在高感染风险人群中的有效性最近受到了质疑。我们旨在确定在我们机构全面改用AIS系统是否导致高危儿科患者分流感染的发生率降低。
我们回顾性分析了1997年1月至2007年12月这10年间在约翰霍普金斯医院接受脑脊液分流手术的所有儿科患者的记录。在2002年10月之前的5.75年里，所有脑脊液分流装置均采用标准的非AIS导管。在2002年10月之后的4.25年里，所有脑脊液分流装置均采用AIS导管。高危亚组被预先定义为早产（胎龄<35周）、脑膜炎后立即放置分流管、将外部脑室引流管（EVD）转换为分流管以及在需要长期住院（>1个月）的患者中替换医院获得性分流感染。
共有544名儿科患者接受了1072次分流管置入手术（502次使用AIS，570次使用非AIS）。使用非AIS导管的患者中有64例（11.2%）发生了分流感染，而使用AIS导管的患者中只有16例（3.2%）发生了分流感染（p<0.001）。在早产儿中，AIS与非AIS相比，分流感染率降低[3例（5.5%）对7例（20.0%），p = 0.030]；在细菌性脑膜炎急性期[2例（5.7%）对9例（25.0%），p = 0.043]；在将EVD转换为分流管时[0例（0%）对4例（13.3%），p = 0.030]；以及在住院时间>1个月的患者中[3例（5.3%）对12例（18.5%），p = 0.022]。金黄色葡萄球菌是使用非AIS（81.3%）和AIS（75.0%）系统时最常见的感染病原体。
在我们的机构实践中引入AIS导管降低了感染风险最高的儿科人群中分流感染的发生率。AIS导管是预防脑脊液分流组件围手术期定植的有效工具。
