美国各儿科医院初次脑脊液分流术后的感染率。临床文章。
Infection rates following initial cerebrospinal fluid shunt placement across pediatric hospitals in the United States. Clinical article.
作者信息
Simon Tamara D, Hall Matthew, Riva-Cambrin Jay, Albert J Elaine, Jeffries Howard E, Lafleur Bonnie, Dean J Michael, Kestle John R W
机构信息
Divisions of Inpatient Medicine, University of Utah, Salt Lake City, Utah, USA.
出版信息
J Neurosurg Pediatr. 2009 Aug;4(2):156-65. doi: 10.3171/2009.3.PEDS08215.
OBJECT
Reported rates of CSF shunt infection vary widely across studies. The study objective was to determine the CSF shunt infection rates after initial shunt placement at multiple US pediatric hospitals. The authors hypothesized that infection rates between hospitals would vary widely even after adjustment for patient, hospital, and surgeon factors.
METHODS
This retrospective cohort study included children 0-18 years of age with uncomplicated initial CSF shunt placement performed between January 1, 2001, and December 31, 2005, and recorded in the Pediatric Health Information System (PHIS) longitudinal administrative database from 41 children's hospitals. For each child with 24 months of follow-up, subsequent CSF shunt infections and procedures were determined.
RESULTS
The PHIS database included 7071 children with uncomplicated initial CSF shunt placement during this time period. During the 24 months of follow-up, these patients had a total of 825 shunt infections and 4434 subsequent shunt procedures. Overall unadjusted 24-month CSF shunt infection rates were 11.7% per patient and 7.2% per procedure. Unadjusted 24-month cumulative incidence rates for each hospital ranged from 4.1 to 20.5% per patient and 2.5-12.3% per procedure. Factors significantly associated with infection (p < 0.05) included young age, female sex, African-American race, public insurance, etiology of intraventricular hemorrhage, respiratory complex chronic condition, subsequent revision procedures, hospital volume, and surgeon case volume. Malignant lesions and trauma as etiologies were protective. Infection rates for each hospital adjusted for these factors decreased to 8.8-12.8% per patient and 1.4-5.3% per procedure.
CONCLUSIONS
Infections developed in > 11% of children who underwent uncomplicated initial CSF shunt placements within 24 months. Patient, hospital, and surgeon factors contributed somewhat to the wide variation in CSF shunt infection rates across hospitals. Additional factors may contribute to variation in CSF shunt infection rates between centers, but further study is needed. Benchmarking and future prospective multicenter studies of CSF shunt infection will need to incorporate these and other patient, hospital, and surgeon factors.
目的
不同研究报告的脑脊液分流感染率差异很大。本研究的目的是确定美国多家儿科医院初次放置脑脊液分流管后的感染率。作者推测，即使在对患者、医院和外科医生因素进行调整后，不同医院之间的感染率仍会有很大差异。
方法
这项回顾性队列研究纳入了2001年1月1日至2005年12月31日期间在41家儿童医院接受初次脑脊液分流管放置且无并发症的0至18岁儿童，这些数据记录在儿科健康信息系统（PHIS）纵向管理数据库中。对于每例随访24个月的儿童，确定其随后的脑脊液分流感染情况及相关操作。
结果
PHIS数据库纳入了该时间段内7071例初次脑脊液分流管放置无并发症的儿童。在24个月的随访期间，这些患者共发生825例分流感染及4434次后续分流操作。总体未经调整的24个月脑脊液分流感染率为每位患者11.7%，每次操作7.2%。各医院未经调整的24个月累积发病率为每位患者4.1%至20.5%，每次操作2.5%至12.3%。与感染显著相关（p<0.05）的因素包括年龄小、女性、非裔美国人种族、公共保险、脑室内出血病因、慢性呼吸系统疾病、后续翻修手术、医院工作量及外科医生病例量。以恶性病变和创伤为病因具有保护作用。对这些因素进行调整后，各医院的感染率降至每位患者8.8%至12.8%，每次操作1.4%至5.3%。
结论
在24个月内接受初次脑脊液分流管放置且无并发症的儿童中，超过11%发生了感染。患者、医院和外科医生因素在一定程度上导致了不同医院脑脊液分流感染率的广泛差异。可能还有其他因素导致各中心脑脊液分流感染率存在差异，但仍需进一步研究。脑脊液分流感染的基准设定及未来前瞻性多中心研究需要纳入这些及其他患者、医院和外科医生因素。
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