Fichtner Jens, Jilch Astrid, Stieglitz Lennart Henning, Beck Jürgen, Raabe Andreas, Z' Graggen Werner J
Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern 3010 Switzerland.
Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern 3010 Switzerland.
Clin Neurol Neurosurg. 2014 Jul;122:70-6. doi: 10.1016/j.clineuro.2014.04.018. Epub 2014 May 1.
Bolt-kit systems are increasingly used as an alternative to conventional external cerebrospinal fluid (CSF) drainage systems. Since 2009 we regularly utilize bolt-kit external ventricular drainage (EVD) systems with silver-bearing catheters inserted manually with a hand drill and skull screws for emergency ventriculostomy. For non-emergency situations, we use conventional ventriculostomy with subcutaneous tunneled silver-bearing catheters, performed in the operating room with a pneumatic drill. This retrospective analysis compared the two techniques in terms of infection rates.
152 patients (aged 17-85 years, mean=55.4 years) were included in the final analysis; 95 received bolt-kit silver-bearing catheters and 57 received conventionally implanted silver-bearing catheters. The primary endpoint combined infection parameters: occurrence of positive CSF culture, colonization of catheter tips, or elevated CSF white blood cell counts (>4/μl). Secondary outcome parameters were presence of microorganisms in CSF or on catheter tips. Incidence of increased CSF cell counts and number of patients with catheter malposition were also compared.
The primary outcome, defined as analysis of combined infection parameters (occurrence of either positive CSF culture, colonization of the catheter tips or raised CSF white blood cell counts >4/μl)was not significantly different between the groups (58.9% bolt-kit group vs. 63.2% conventionally implanted group, p=0.61, chi-square-test). The bolt-kit group was non-inferior and not superior to the conventional group (relative risk reduction of 6.7%; 90% confidence interval: -19.9% to 25.6%). Secondary outcomes showed no statistically significant difference in the incidence of microorganisms in CSF (2.1% bolt-kit vs. 5.3% conventionally implanted; p=0.30; chi-square-test).
This analysis indicates that silver-bearing EVD catheters implanted with a bolt-kit system outside the operating room do not significantly elevate the risk of CSF infection as compared to conventional implant methods.
螺栓套件系统越来越多地被用作传统外部脑脊液（CSF）引流系统的替代品。自2009年以来，我们经常使用螺栓套件进行体外脑室引流（EVD）系统，通过手动使用手钻和颅骨螺钉插入含银导管进行紧急脑室造瘘术。对于非紧急情况，我们在手术室使用气动钻进行常规脑室造瘘术，并植入皮下隧道含银导管。本回顾性分析比较了这两种技术的感染率。
152例患者（年龄17 - 85岁，平均55.4岁）纳入最终分析；95例接受螺栓套件含银导管，57例接受传统植入含银导管。主要终点为综合感染参数：脑脊液培养阳性、导管尖端定植或脑脊液白细胞计数升高（>4/μl）。次要结局参数为脑脊液或导管尖端存在微生物。还比较了脑脊液细胞计数增加的发生率和导管位置不当的患者数量。
主要结局定义为综合感染参数分析（脑脊液培养阳性、导管尖端定植或脑脊液白细胞计数>4/μl），两组之间无显著差异（螺栓套件组为58.9%，传统植入组为63.2%，p = 0.61，卡方检验）。螺栓套件组不劣于也不优于传统组（相对风险降低6.7%；90%置信区间：-19.9%至25.6%）。次要结局显示，脑脊液中微生物的发生率无统计学显著差异（螺栓套件组为2.1%，传统植入组为5.3%；p = 0.30；卡方检验）。
该分析表明，与传统植入方法相比，在手术室之外使用螺栓套件系统植入含银EVD导管不会显著增加脑脊液感染风险。
