Winston Ken R, Ho Joseph T, Dolan Susan A
Department of Neurosurgery, The University of Colorado Denver School of Medicine, Denver, CO, USA.
J Neurosurg Pediatr. 2013 Jun;11(6):635-42. doi: 10.3171/2013.3.PEDS12478. Epub 2013 Apr 19.
The objective of this investigation was to review the clinical characteristics of recurrent CSF shunt infections in a large pediatric neurosurgical practice and to assess the safety and efficacy of reusing original ventricular entry sites for external ventricular drainage during treatment of infections and for subsequent reinsertion of shunts.
Prospectively accrued clinical data on all patients treated at Children's Hospital Colorado for CSF shunt infections within a 10.5-year span were retrospectively investigated.
One hundred twenty-one consecutive cases of CSF shunt infection met inclusion criteria. Recurrent shunt infection attributable to the management of these infections occurred in 14 cases (11.6%). Three recurrent infections were with their original organisms, 7 were organisms different from the original organisms, and 4 were indeterminate.
Half or more of recurrent shunt infections were with organisms different from the original organism, and hence were new-type infections introduced during the management of the original infections. Incomplete eradication of original pathogens accounted for 3 (21.4%) of the 14 recurrent infections. Reusing recently infected or contaminated ventricular entry sites, both for CSF drainage during treatment and for implantation of new shunts, was as safe, with regard to risk of recurrent infection, as switching to new entry sites. Prior evidence of shunt infection is not, alone, a sufficient reason to change to a previously well-functioning site, and reuse of contaminated ventricular entry sites avoids all risks associated with making new ventricular entries.
本研究的目的是回顾一家大型儿科神经外科机构中复发性脑脊液分流感染的临床特征，并评估在感染治疗期间以及随后重新插入分流器时，重新使用原始脑室穿刺部位进行外部脑室引流的安全性和有效性。
回顾性研究了科罗拉多儿童医院在10.5年期间治疗的所有脑脊液分流感染患者的前瞻性累积临床数据。
121例连续的脑脊液分流感染病例符合纳入标准。因这些感染的管理导致的复发性分流感染发生在14例（11.6%）。3例复发性感染的病原体与原始病原体相同，7例与原始病原体不同，4例无法确定。
半数或更多的复发性分流感染的病原体与原始病原体不同，因此是在原始感染管理期间引入的新型感染。14例复发性感染中有3例（21.4%）是由于原始病原体未完全根除。在治疗期间进行脑脊液引流以及植入新的分流器时，重新使用最近感染或污染的脑室穿刺部位，就复发性感染风险而言，与更换到新的穿刺部位一样安全。分流感染的既往证据本身并不是更换到先前功能良好部位的充分理由，并且重复使用受污染的脑室穿刺部位可避免与进行新的脑室穿刺相关的所有风险。
