Raffa Giovanni, Marseglia Lucia, Gitto Eloisa, Germanò Antonino
Neurosurgical Clinic, Department of Neurosciences, University of Messina, Via Consolare Valeria 1, Messina, 98125, Italy,
Childs Nerv Syst. 2015 Jul;31(7):1129-38. doi: 10.1007/s00381-015-2685-7. Epub 2015 Mar 28.
The incidence of ventriculoperitoneal (VP) shunt infection accounts for about 5-15%, but it can rise up to 70% in specific high-risk subgroups. Antibiotic-impregnated catheters (AICs) have been designed to reduce shunt infections, but reports on their efficacy are discordant, especially in young children. The aim of this study is to assess, for the first time, the efficacy of AICs in newborns and infants at very high risk for shunt infection.
We reviewed the medical records of newborns and infants treated with a VP shunt for newly diagnosed hydrocephalus. Patients were divided in two groups: Group A was composed by children who received AICs, whereas Group B included children implanted with standard silicone catheters (non-AICs). We compared the shunt infection rate in both groups, and analyzed differences in specific high-risk subgroups (preterm newborns, children with posthemorrhagic or postinfective hydrocephalus, and children with a previous external ventricular drainage).
Forty eight children younger than 1 year old were included in our study. Twenty two patients were implanted with an AIC, whereas 26 patients received a standard silicone catheter. The follow-up was at least 1 year (mean 8 ± 3 years). The overall infection rate decreased from 34% in non-AIC group to 9 % in the AIC group. Moreover, AICs showed to have a protective effect against shunt infections in all the specific high-risk subgroups analyzed.
This study demonstrates for the first time that AICs are effective in reducing VP shunt infection in high-risk pediatric patients younger than 1 year old.
脑室腹腔（VP）分流感染的发生率约为5%-15%，但在特定的高危亚组中可高达70%。抗生素浸渍导管（AIC）旨在减少分流感染，但关于其疗效的报道并不一致，尤其是在幼儿中。本研究的目的是首次评估AIC对分流感染极高风险的新生儿和婴儿的疗效。
我们回顾了因新诊断脑积水而接受VP分流治疗的新生儿和婴儿的病历。患者分为两组：A组由接受AIC的儿童组成，而B组包括植入标准硅胶导管（非AIC）的儿童。我们比较了两组的分流感染率，并分析了特定高危亚组（早产新生儿、出血后或感染后脑积水患儿以及曾有外部脑室引流的患儿）的差异。
我们的研究纳入了48名1岁以下儿童。22例患者植入了AIC，而26例患者接受了标准硅胶导管。随访至少1年（平均8±3年）。总体感染率从非AIC组的34%降至AIC组的9%。此外，在所有分析的特定高危亚组中，AIC对分流感染均显示出保护作用。
本研究首次证明AIC可有效降低1岁以下高危儿科患者的VP分流感染。
