Demetriades Andreas K, Bassi Sanj
Department of Neurosurgery, King's College Hospital, London SE5 9RS, UK.
Br J Neurosurg. 2011 Dec;25(6):671-3. doi: 10.3109/02688697.2011.575478. Epub 2011 Jun 27.
Shunts remain the commonest means by which hydrocephalus is treated. Despite the changes in valve and catheter technology, shunt infection and blockage are still a cause of great headache for the patient as well as the neurosurgeon. Antibiotic-laced catheters were proposed as a means by which to reduce shunt colonization and infection.
We present our experience of 52 months of Bactiseal catheters in all consecutive patients who underwent a ventriculoperitoneal (VP) shunt from July 2004 to November 2008, under the care of one neurosurgeon. This was a prospective study with outcome measures of infection, blockage, intra and postoperative complications and revision surgery.
One hundred and twenty-five patients underwent VP shunting with Bactiseal catheters, with a combination of NSC, Strata and Burr Hole valves. The age range of the patients was from 1 week premature to 64-years old. Forty-two of the patients were paediatric. The aetiology for hydrocephalus included posterior fossa tumoursto intra-ventricular haemorrhage, post-meningitic hydrocephalus and aqueduct stenosis. The overall complication rate was 12%. The following complications occurred: blockage in two cases; haemorrhage and blockage in two cases; CSF leak in one case; infection in four cases; other in three cases (peritoneal adhesions, wound erosion and postoperative peritonitis). There were four infections in total (3.2%). All of these occurred within six months of implantation. All infections were caused by rifampicin resistant Staphylococcus epidermidis.
In an era of increasing methicillin-resistant Staphylococcus aureus (MRSA) resistance and 'superbugs', is the use of antibiotic-laced catheters adding to the pool of resistant bacteria which may be harder to treat? Vigilance is required, as rare and resistant staphylococci strains occasionally can emerge as causative agents for VP shunt infections, in both adults and children, and their treatment can be difficult.
分流术仍然是治疗脑积水最常用的方法。尽管阀门和导管技术有所改进，但分流感染和堵塞仍然是患者和神经外科医生极为头疼的问题。含抗生素导管被提议作为减少分流管定植和感染的一种手段。
我们介绍了在一位神经外科医生的照料下，2004年7月至2008年11月期间所有连续接受脑室腹腔（VP）分流术的患者使用抗菌导管52个月的经验。这是一项前瞻性研究，其结果指标包括感染、堵塞、术中和术后并发症以及翻修手术。
125例患者使用抗菌导管进行了VP分流术，使用的阀门组合包括NSC、Strata和钻孔阀。患者年龄范围从1周早产到64岁。其中42例为儿科患者。脑积水的病因包括后颅窝肿瘤、脑室内出血、脑膜炎后脑积水和导水管狭窄。总体并发症发生率为12%。发生了以下并发症：2例堵塞；2例出血和堵塞；1例脑脊液漏；4例感染；3例其他情况（腹膜粘连、伤口糜烂和术后腹膜炎）。总共发生了4例感染（3.2%）。所有这些感染均发生在植入后六个月内。所有感染均由耐利福平表皮葡萄球菌引起。
在耐甲氧西林金黄色葡萄球菌（MRSA）耐药性增加和“超级细菌”的时代，使用含抗生素导管是否会增加可能更难治疗的耐药菌数量？需要保持警惕，因为罕见且耐药的葡萄球菌菌株偶尔会成为成人和儿童VP分流感染的病原体，而且其治疗可能很困难。
