James Greg, Hartley John C, Morgan Robert D, Ternier Jessica
Departments of Neurosurgery and.
J Neurosurg Pediatr. 2014 Jan;13(1):101-6. doi: 10.3171/2013.10.PEDS13189. Epub 2013 Nov 8.
Infection after both primary and revision shunt surgeries remains a major problem in pediatric neurosurgical practice. Antibiotic-impregnated shunt (AIS) tubing has been proposed to reduce infection rates. The authors report their experience with AIS catheters in their large pediatric neurosurgery department.
The authors conducted a retrospective case review of consecutive shunt operations performed before (1993-2003) and after (2005-2009) introduction of AIS tubing, with analysis of shunt infection rates and causative organisms identified.
The historical control group consisted of 1592 consecutive shunt operations (657 primary insertions), and the AIS study group consisted of 500 consecutive shunt operations (184 primary insertions). Patients ranged in age from 0-17 years. In the historical group, 135 infections were identified (8.4%). In the AIS study group, 25 infections were identified (5%), representing a significant reduction (p < 0.005). The latency to diagnosis of infection was 23 days in the historical group and 139 days in the AIS study group. The infection rates in infants 0-6 months of age were 12.2% (historical group) and 6.7% (AIS group, p < 0.005), and in infants 7-12 months of age the rates were 7.9% (historical group) and 2.7% (AIS group, p < 0.005). In the historical control group, the frequency rank order of causative organisms was coagulase-negative staphylococcus (51.9%), Staphylococcus aureus (31.6%), streptococcus or enterococcus spp. (8.8%), gram-negative organisms (4.4%), and Propionibacterium acnes (2.2%). Organisms responsible for infections in AIS were S. aureus (40%), followed by streptococcus or enterococcus spp. (20%), P. acnes and coagulase-negative staphylococcus (both 16%), and gram-negative organisms (4%). No unusually antibiotic-resistant bacteria were identified in either group. The authors further subdivided the AIS group into those undergoing primary AIS insertion (Subgroup 1), those undergoing revision of non-AIS systems using AIS components (Subgroup 2), and those undergoing revision of AIS systems using AIS components (Subgroup 3). Infection rates were 1.6% in Subgroup 1, 2.5% in Subgroup 2, and 11.7% in Subgroup 3. Staphylococcus aureus was the most common organism identified in infections of the Subgroups 2 and 3.
Use of AIS tubing significantly improves shunt infection rates in both general pediatric and infant populations with no evidence of increased antibiotic resistance, which is in agreement with previous studies. However, the increased infection rate in revision surgery in children with AIS catheters in situ raises questions about their long-term application.
在小儿神经外科手术中，初次分流手术和翻修分流手术后的感染仍然是一个主要问题。有人提出使用含抗生素的分流（AIS）管来降低感染率。作者报告了他们在大型小儿神经外科科室使用AIS导管的经验。
作者对引入AIS管之前（1993 - 2003年）和之后（2005 - 2009年）连续进行的分流手术进行了回顾性病例分析，分析了分流感染率及鉴定出的致病微生物。
历史对照组包括1592例连续分流手术（657例初次植入），AIS研究组包括500例连续分流手术（184例初次植入）。患者年龄范围为0至17岁。在历史组中，发现135例感染（8.4%）。在AIS研究组中，发现25例感染（5%），感染率显著降低（p < 0.005）。历史组感染诊断的潜伏期为23天，AIS研究组为139天。0至6个月婴儿的感染率在历史组为12.2%，在AIS组为6.7%（p < 0.005）；7至12个月婴儿的感染率在历史组为7.9%，在AIS组为2.7%（p < 0.005）。在历史对照组中，致病微生物的频率排序为凝固酶阴性葡萄球菌（51.9%）、金黄色葡萄球菌（31.6%）、链球菌或肠球菌属（8.8%）、革兰氏阴性菌（4.4%）和痤疮丙酸杆菌（2.2%）。AIS感染的致病微生物为金黄色葡萄球菌（40%），其次是链球菌或肠球菌属（20%）、痤疮丙酸杆菌和凝固酶阴性葡萄球菌（均为16%）以及革兰氏阴性菌（4%）。两组均未发现异常耐药菌。作者将AIS组进一步细分为接受初次AIS植入的患者（亚组1）、使用AIS组件对非AIS系统进行翻修的患者（亚组2）以及使用AIS组件对AIS系统进行翻修的患者（亚组3）。亚组1的感染率为1.6%，亚组2为2.5%，亚组3为11.7%。金黄色葡萄球菌是亚组2和亚组3感染中最常见的微生物。
使用AIS管可显著提高普通小儿和婴儿人群的分流感染率，且无抗生素耐药性增加的证据，这与先前的研究一致。然而，原位植入AIS导管的儿童翻修手术中感染率的增加引发了对其长期应用的质疑。
