Richards Hugh K, Seeley Helen M, Pickard John D
United Kingdom Shunt Registry, Addenbrooke's Hospital, Cambridge, United Kingdom.
J Neurosurg Pediatr. 2009 Oct;4(4):389-93. doi: 10.3171/2009.4.PEDS09210.
In recent years CSF shunt catheters impregnated with rifampicin and clindamycin have been introduced to the United Kingdom (UK) market. These catheters have been shown to be effective in vitro against cultures of Staphylococcus epidermidis. The authors used data collected by the UK Shunt Registry to assess the efficacy of antibiotic-impregnated catheters (AICs) against shunt infection by using a matched-pair study design.
The UK Shunt Registry contains data on nearly 33,000 CSF shunt-related procedures. The authors identified 1139 procedures in which impregnated catheters had been used, and accurate information was known about diagnosis, number of revisions, sex, and age in these cases. The database was ordered chronologically and searched forward and backward for cases with these same characteristics but involving conventional catheters. Matches were found for 994 procedures.
Among the 994 procedures in which AICs had been used, 30 shunts were subsequently revised because of shunt infection. Among the 994 controls, 47 were subsequently revised for infection (p = 0.048, chi-square test).
The UK Shunt Registry does not collect data on causative organisms, and the surgeon is relied on entirely for the diagnosis of infection. However, with the large number of matched pairs evaluated, the authors attempted to reduce bias to a minimum. Their data suggest that AICs have the potential to significantly reduce shunt infections.
近年来，含有利福平和克林霉素的脑脊液分流导管已进入英国市场。这些导管已被证明在体外对表皮葡萄球菌培养物有效。作者使用英国分流登记处收集的数据，通过配对研究设计评估抗生素浸渍导管（AIC）预防分流感染的疗效。
英国分流登记处包含近33,000例脑脊液分流相关手术的数据。作者确定了1139例使用浸渍导管的手术，并掌握了这些病例的准确诊断、翻修次数、性别和年龄信息。数据库按时间顺序排序，向前和向后搜索具有相同特征但使用传统导管的病例。共找到994例匹配病例。
在使用AIC的994例手术中，有30例分流管因分流感染而随后进行了翻修。在994例对照病例中，有47例因感染而随后进行了翻修（卡方检验，p = 0.048）。
英国分流登记处不收集病原体数据，感染诊断完全依赖外科医生。然而，通过评估大量匹配对，作者试图将偏差降至最低。他们的数据表明，AIC有显著降低分流感染的潜力。
