Schroeder Humberto Kluge, Nunes Jean Costa, Madeira Luciano, Moritz Jorge Luis Wollstein, Walz Roger, Linhares Marcelo Neves
Serviço de Neurocirurgia, Hospital Governador Celso Ramos (HGCR), Florianópolis, Santa Catarina (SC), Brazil.
Clin Neurol Neurosurg. 2012 Sep;114(7):981-5. doi: 10.1016/j.clineuro.2012.02.034. Epub 2012 Mar 16.
We investigate the demographic, clinical and surgical variables associated with wound and ventriculoperitoneal (VP) shunt infections in a well-defined group of patients submitted to neurosurgical myelomeningocele repair.
We analyzed the data of sixty consecutive patients with a myelomeningocele diagnosis submitted to neurosurgical repair between January 2002 and December 2005. Multiple logistic regression analysis identified clinical, demographic and neurosurgical variables that were independently associated with the occurrence of wound and VP shunt infections.
Seven patients (11.7%) developed wound infections after myelomeningocele repair and two (3.3%) presented with sepsis unrelated to the neurosurgical procedures. Forty-six patients (76.7%) received a VP shunt and nine of them (19.6%) had VP shunt infection. There was a non-significant trend (p=0.09) for a higher association between thoracic than lumbar or sacral topography and the occurrence of any type of infection. Among patients who underwent VP shunt placement, there was a non-significant trend for a higher association between VP shunt infection and thoracic topography compared to lumbar or sacral regions (adjusted OR 4.3; CI 95% 0.7-24.7; p=0.10). Evans' index scores higher than 70 were ten times more associated with VP shunt infection (adjusted OR 10.5; CI 95% 1.6-67.4; p=0.01) than lower scores.
The thoracic topography of myelomeningocele has a trend for a higher association with infection in general and VP shunt infection. Evans' index scores higher than 70 were independently associated with VP shunt infection.
在一组明确的接受神经外科脊髓脊膜膨出修补术的患者中，我们研究与伤口及脑室腹腔（VP）分流感染相关的人口统计学、临床和手术变量。
我们分析了2002年1月至2005年12月间连续60例诊断为脊髓脊膜膨出并接受神经外科修补术患者的数据。多因素逻辑回归分析确定了与伤口及VP分流感染发生独立相关的临床、人口统计学和神经外科变量。
7例患者（11.7%）在脊髓脊膜膨出修补术后发生伤口感染，2例（3.3%）出现与神经外科手术无关的败血症。46例患者（76.7%）接受了VP分流，其中9例（19.6%）发生VP分流感染。胸椎部位与腰椎或骶椎部位相比，与任何类型感染的相关性有升高趋势，但差异无统计学意义（p=0.09）。在接受VP分流置入的患者中，与腰椎或骶椎区域相比，VP分流感染与胸椎部位的相关性有升高趋势，但差异无统计学意义（校正比值比4.3；95%可信区间0.7 - 24.7；p=0.10）。Evans指数评分高于70分与VP分流感染的相关性比低分高10倍（校正比值比10.5；95%可信区间1.6 - 67.4；p=0.01）。
脊髓脊膜膨出的胸椎部位总体上与感染尤其是VP分流感染的相关性有升高趋势。Evans指数评分高于70分与VP分流感染独立相关。
