Menardi G
Abteilung für Kinderchirurgie der I. Universitätsklinik für Chirurgie, Innsbruck.
Padiatr Padol. 1989;24(1):43-8.
The treatment of infectious complications of implanted foreign bodies into the CNS is unsatisfactory. In the majority of these patients staphylococci are responsible for these infections which elicit only a smoldering inflammatory response with poor penetration of antibiotics into the CSF. It is also very difficult to eradicate staphylococci from the surface of silastic material by antibiotics. Fosfomycin was investigated in the treatment of CSF infections in patients with infected ventriculoatrial shunts. Fosfomycin exhibits a potent antimicrobial activity against staphylococci; this drug also showed a favourable penetration into the CSF in moderately inflamed meninges. A 10 days therapeutic course with fosfomycin plus oxacillin or cefamandole and gentamycin in combination with external drainage of the CSF into a closed system made it possible to exchange all parts of the system in one session without reinfection. This procedure was followed by the same antibiotic regimen postoperatively for 10-14 days. Under this treatment schedule therapeutic results have been considerably better compared to previous treatment modalities.
植入中枢神经系统的异物引起的感染并发症的治疗效果并不理想。在大多数这类患者中，葡萄球菌是这些感染的病原体，它们仅引发一种隐匿性炎症反应，抗生素难以穿透进入脑脊液。通过抗生素从硅橡胶材料表面根除葡萄球菌也非常困难。研究了磷霉素在治疗感染性脑室心房分流患者脑脊液感染中的作用。磷霉素对葡萄球菌具有强大的抗菌活性；在中度炎症的脑膜中，这种药物也显示出良好的脑脊液穿透性。采用磷霉素加苯唑西林或头孢孟多以及庆大霉素联合治疗10天，并将脑脊液通过外部引流至封闭系统，使得可以在一次手术中更换系统的所有部件而不会再次感染。术后按照相同的抗生素方案再治疗10 - 14天。与先前的治疗方式相比，在这种治疗方案下治疗效果有了显著改善。
