Gruber Thomas J, Riemer Sara, Rozzelle Curtis J
Department of Neurosurgery, Women and Children's Hospital of Buffalo, Kaleida Health, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14209, USA.
Pediatr Neurosurg. 2009;45(6):456-60. doi: 10.1159/000277621. Epub 2010 Jan 26.
BACKGROUND/AIMS: Various factors have been associated with cerebrospinal fluid (CSF) shunt infection risk, leading to many recommendations intended to reduce that risk. We sought to assess current North American pediatric neurosurgical practice patterns in this regard via a web-based survey. Particular attention was paid to the use of antibiotic-impregnated materials and prophylactic perioperative antibiotics.
The membership of the section on pediatric neurological surgery of the American Association of Neurological Surgeons and Congress of Neurological Surgeons was invited to complete a survey of current practices intended to minimize CSF shunt infection risk. To be eligible for participation in this study, the respondent had to maintain an active neurosurgical practice within North America and place or revise at least 25 shunts in pediatric patients (<21 years) per year. Responses to the questionnaire were then analyzed.
A total of 100 responses were analyzed. All respondents were familiar with antibiotic-impregnated shunt catheters, and 61 of 100 had actually used them. Eleven of 61 respondents use them universally, 20 of 61 in >50% of cases, and 30 of 61 in <50% of cases. Antibiotic-impregnated suture material was known to 59% of respondents, of whom 28% (14 of 59) reported having actually used antimicrobial suture. All respondents use perioperative intravenous antibiotics with vancomycin, first-generation cephalosporins, and then second-generation cephalosporins being the most common. Routine use of intraventricular antibiotics was reported by 27%. An assessment of surgical techniques revealed that 90% limit shunt contact with patient's skin, 62% use the double-gloving technique, 45% handle shunt components only with instruments, and 34% use an antiseptic shampoo preoperatively.
Our survey reveals a wide range of practices intended to prevent shunt infection and captures, in particular, current trends in the use of antibiotic-impregnated materials and perioperative antibiotics for CSF shunting procedures.
背景/目的：多种因素与脑脊液（CSF）分流感染风险相关，从而产生了许多旨在降低该风险的建议。我们试图通过一项基于网络的调查来评估当前北美儿科神经外科在这方面的实践模式。特别关注了含抗生素材料和围手术期预防性抗生素的使用情况。
邀请美国神经外科医师协会和神经外科医师大会儿科神经外科学组的成员完成一项关于当前旨在将CSF分流感染风险降至最低的实践的调查。要符合参与本研究的条件，受访者必须在北美积极从事神经外科实践，并且每年为儿科患者（<21岁）置入或更换至少25根分流管。然后对问卷回复进行分析。
共分析了100份回复。所有受访者都熟悉含抗生素的分流导管，100人中有61人实际使用过。61名受访者中，11人普遍使用；61人中20人在超过50%的病例中使用；61人中30人在不到50%的病例中使用。59%的受访者知道含抗生素的缝合材料，其中28%（59人中的14人）报告实际使用过抗菌缝线。所有受访者围手术期均使用静脉抗生素，最常用的是万古霉素、第一代头孢菌素，然后是第二代头孢菌素。27%的受访者报告常规使用脑室内抗生素。对外科技术的评估显示，90%的人限制分流管与患者皮肤接触，62%的人使用双层手套技术，45%的人仅用器械处理分流组件，34%的人术前使用抗菌洗发水。
我们的调查揭示了旨在预防分流感染的广泛实践，尤其捕捉到了CSF分流手术中含抗生素材料和围手术期抗生素使用的当前趋势。
