标准化方案和抗生素浸渍导管对脑血管病患者脑室引流感染率的影响。
Impact of a standardized protocol and antibiotic-impregnated catheters on ventriculostomy infection rates in cerebrovascular patients.
机构信息
Department of Neurosurgery, Jefferson Medical College, and Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107, USA.
出版信息
Neurosurgery. 2010 Jul;67(1):187-91; discussion 191. doi: 10.1227/01.NEU.0000370247.11479.B6.
BACKGROUND
Ventriculostomy infections create significant morbidity. To reduce infection rates, a standardized evidence-based catheter insertion protocol was implemented. A prospective observational study analyzed the effects of this protocol alone and with antibiotic-impregnated ventriculostomy catheters.
OBJECTIVE
To compare infection rates after implementing a standardized protocol for ventriculostomy catheter insertion with and without the use of antibiotic-impregnated catheters.
METHODS
Between 2003 and 2008, 1961 ventriculostomies and infections were documented. A ventriculostomy infection was defined as 2 positive CSF cultures from ventriculostomy catheters with a concurrent increase in cerebrospinal fluid white blood cell count. A baseline (preprotocol) infection rate was established (period 1). Infection rates were monitored after adoption of the standardized protocol (period 2), institution of antibiotic-impregnated catheter A (period 3), discontinuation of antibiotic-impregnated catheter A (period 4), and institution of antibiotic-impregnated catheter B (period 5).
RESULTS
The baseline infection rate (period 1) was 6.7% (22/327 devices). Standardized protocol (period 2) implementation did not change the infection rate (8.2%; 23/281 devices). Introduction of catheter A (period 3) reduced infections to 1.0% (2/195 devices, P=.0005). Because of technical difficulties, this catheter was discontinued (period 4), resulting in an increase in infection rate (7.6%; 12/157 devices). Catheter B (period 5) significantly decreased infections to 0.9% (9 of 1001 devices, P=.0001). The Staphylococcus infection rate for periods 1, 2, and 4 was 6.1% (47/765) compared with 0.2% (1/577) during use of antibiotic-impregnated catheters (periods 3 and 5).
CONCLUSION
The use of antibiotic-impregnated catheters resulted in a significant reduction of ventriculostomy infections and is recommended in the adult neurosurgical population.
背景
脑室引流感染会导致严重的发病率。为了降低感染率，我们实施了一项标准化的循证导管插入协议。一项前瞻性观察性研究分析了该协议单独使用和与抗生素浸渍脑室引流导管联合使用的效果。
目的
比较使用标准化脑室引流导管插入协议与不使用抗生素浸渍导管时的感染率。
方法
2003 年至 2008 年期间，共记录了 1961 例脑室引流和感染病例。脑室引流感染的定义为脑室引流导管连续两次培养出阳性的脑脊液，同时伴有脑脊液白细胞计数增加。建立了基线（预协议）感染率（第 1 期）。在采用标准化方案（第 2 期）后监测感染率，使用抗生素浸渍导管 A（第 3 期），停止使用抗生素浸渍导管 A（第 4 期），以及使用抗生素浸渍导管 B（第 5 期）。
结果
基线感染率（第 1 期）为 6.7%（22/327 个装置）。标准化方案（第 2 期）的实施并未改变感染率（8.2%；23/281 个装置）。引入导管 A（第 3 期）将感染率降低至 1.0%（2/195 个装置，P=.0005）。由于技术困难，该导管被停用（第 4 期），导致感染率增加（7.6%；157 个装置中的 12 个）。使用导管 B（第 5 期）可显著降低感染率至 0.9%（1001 个装置中的 9 个，P=.0001）。第 1、2 和 4 期的金黄色葡萄球菌感染率为 6.1%（47/765），而在使用抗生素浸渍导管（第 3 和 5 期）时感染率为 0.2%（1/577）。
结论
使用抗生素浸渍导管可显著降低脑室引流感染率，建议在成人神经外科人群中使用。
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