Parker Scott L, Anderson William N, Lilienfeld Sean, Megerian J Thomas, McGirt Matthew J
The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
J Neurosurg Pediatr. 2011 Sep;8(3):259-65. doi: 10.3171/2011.6.PEDS11257.
Cerebrospinal fluid shunt infections are associated with significant morbidity and mortality in the treatment of adult and pediatric hydrocephalus. Antibiotic-impregnated shunt (AIS) catheters have been used with the aim of reducing shunt infection. While many studies have demonstrated a reduction in shunt infection with AIS, this reported efficacy has varied within the literature.
The authors performed a systematic literature review to identify all published articles comparing the incidence of CSF shunt infection in AIS versus non-AIS catheters. The incidence of infection for AIS versus non-AIS catheters was calculated using the Mantel-Haenszel common odds ratio, and baseline demographics were compared between AIS and non-AIS cohorts.
Twelve AIS versus non-AIS cohort comparisons were identified in the literature (5 pediatric hydrocephalus, 3 adult hydrocephalus, and 4 mixed populations). In a total of 5613 reported shunt procedures (2664 AISs vs 2949 non-AISs), AISs were associated with a reduction in shunt infection (3.3% vs 7.2%; OR 0.439, p < 0.0001). In 787 shunt procedures for adult hydrocephalus (427 AIS vs 360 non-AIS), AISs were associated with reduction in shunt infection (0.9% vs 5.8%; OR 0.153, p < 0.0001). In 1649 shunt procedures for pediatric hydrocephalus (854 AIS vs 795 non-AIS), AISs were associated with reduction in shunt infection (5.0% vs 11.2%; OR 0.421, p < 0.0001).
The authors' systematic review of the literature demonstrates that AIS catheters are associated with a significant reduction over non-AIS catheters in the reported incidence of CSF shunt infection in adult and pediatric populations. The AIS catheters do not appear to be associated with an increased incidence of antibiotic-resistant microorganisms. Prospective, randomized trials are needed to firmly assess and confirm this apparent difference in infection incidence.
在成人和儿童脑积水治疗中，脑脊液分流感染与显著的发病率和死亡率相关。抗生素浸渍分流（AIS）导管已被用于降低分流感染。虽然许多研究表明AIS可降低分流感染，但文献报道的这种疗效存在差异。
作者进行了一项系统的文献综述，以确定所有已发表的比较AIS导管与非AIS导管脑脊液分流感染发生率的文章。使用Mantel-Haenszel共同比值比计算AIS导管与非AIS导管的感染发生率，并比较AIS队列和非AIS队列的基线人口统计学特征。
文献中确定了12项AIS与非AIS队列比较（5项儿童脑积水、3项成人脑积水和4项混合人群）。在总共5613例报告的分流手术中（2664例AIS与2949例非AIS），AIS与分流感染减少相关（3.3%对7.2%；OR 0.439，p<0.0001）。在787例成人脑积水分流手术中（427例AIS对360例非AIS），AIS与分流感染减少相关（0.9%对5.8%；OR 0.153，p<0.0001）。在1649例儿童脑积水分流手术中（854例AIS对795例非AIS），AIS与分流感染减少相关（5.0%对11.2%；OR 0.421，p<0.0001）。
作者对文献的系统综述表明，在成人和儿童人群中，AIS导管与报道的脑脊液分流感染发生率显著低于非AIS导管相关。AIS导管似乎与抗生素耐药微生物的发生率增加无关。需要进行前瞻性随机试验来严格评估和确认这种明显的感染发生率差异。
