Department of Neurosurgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland.
Department of Neurosurgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland.
J Clin Neurosci. 2014 Apr;21(4):578-82. doi: 10.1016/j.jocn.2013.05.025. Epub 2013 Aug 14.
The diagnosis of infections involving internal or external neurosurgical drainage devices is challenging, and to our knowledge no single reliable microbiological test exists. We used sonication to study bacterial colonization in 14 explanted external ventricular drains (EVD) and 13 ventriculo-peritoneal shunt (VPS) devices. This technique dislodges biofilm bacteria from the surface of implanted materials before culture. Removed devices were sonicated in saline (40 kHz, 1 minute, 0.25 W/cm(2)), the resulting fluid was cultured aerobically and anaerobically at 37°C, and bacterial growth was counted. Ventricular cerebrospinal fluid (CSF) was cultured separately. In the EVD group, sonication cultures grew significantly more bacteria (64%, 9/14) than cultures of aspirated ventricular CSF (14%, 2/14). In the VPS group the difference was not significant. Positive sonication cultures of EVD catheters yielded a median of >100 colony forming units (CFU) (range, 60-800). For positive sonication cultures of VPS, the median was 1000 CFU (range, 20-100,000). All patients with bacteria in their CSF also had positive sonication cultures from the removed device. Of the five patients with sterile or presumably contaminated CSF cultures but positive sonication cultures of removed shunts, one became afebrile after removal of the EVD, two developed meningitis and two remained asymptomatic. Sonication culture of EVD appears to improve the microbiological assessment of device-related infection and it corroborates with CSF cultures of revision surgery for VPS. Sonication of the removed EVD tip may raise awareness for the onset of meningitis.
我们使用超声清洗技术研究了 14 个外置脑室引流管（EVD）和 13 个脑室-腹腔分流管（VPS）装置中细菌的定植情况。这项技术在培养前，通过超声振动将植入材料表面的生物膜细菌洗脱下来。将取出的装置在生理盐水中进行超声处理（40 kHz，1 分钟，0.25 W/cm(2)），然后将得到的液体在 37°C 下进行需氧和厌氧培养，并对细菌生长进行计数。同时，还对脑室脑脊液（CSF）进行了单独培养。在 EVD 组中，超声培养的细菌生长明显多于脑室 CSF 抽吸培养（64%，9/14）。在 VPS 组中，差异不显著。EVD 导管阳性超声培养的中位菌落形成单位（CFU）数>100（范围 60-800）。VPS 阳性超声培养的中位 CFU 数为 1000（范围 20-100,000）。所有脑脊液中有细菌的患者，其取出的装置的超声培养也为阳性。在 5 名 CSF 培养无菌或疑似污染，但取出的分流器超声培养阳性的患者中，1 名在取出 EVD 后不再发热，2 名发展为脑膜炎，2 名无症状。EVD 的超声培养似乎提高了对与装置相关感染的微生物评估，并且与 VPS 翻修手术的 CSF 培养结果相符。EVD 尖端的超声清洗可能会引起人们对脑膜炎发作的警觉。
