Xu Hao, Huang Yimin, Jiao Wei, Sun Wei, Li Ran, Li Jiaqing, Lei Ting
Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan Department of Neurosurgery, Anhui Provincial Hospital, Hefei, Anhui, China.
Medicine (Baltimore). 2016 Jul;95(29):e4252. doi: 10.1097/MD.0000000000004252.
Shunt infection is a morbid complication of cerebrospinal fluid (CSF) shunting. The catheters with a hydrophilic surface may impede bacterial adherence and thereby reduce catheter-related CSF infection.A retrospective study compared the occurrence of CSF infection related to use of either standard silastic catheters or hydrogel-coated ventricular catheters (Bioglide, Medtronic). The enrolment was available to neurosurgery patients undergoing shunt surgery from October 2012 to 2015 in two centers. The follow-up period was more than months.A total of 78 patients were included in the study. In 33 patients 35-cm hydrogel-coated ventricular peritoneum shunts (VPS) were used, and in remaining 45 patients 35-cm standard silastic VPS catheters were used. Infection occurred in 14 (17.9%) patients, including definite VPS-related CSF infection in 6 patients (7.7%) and probable infection in remaining 8 patients (10.3%). There was a significant difference found in patients with total infection between the two groups [RR (95% CI); 0.200 (0.050-0.803), P = 0.014]. Analysis of Kaplan-Meier curve estimates indicated significant statistical difference between the two catheter types in duration (log rank = 4.204, P < 0.05). Significant statistical differences were also found in the subgroups including previous CSF infection within 1 month (log rank = 4.391, P = 0.04), conversion of external ventricular drains to shunt (Log Rank = 4.520, P = 0.03), and hospital stay >1 month (log rank = 5.252, P = 0.02). There was no difference found between the two groups of the patients with other infections within 1 month. The follow-up period was of 36 months.The hydrogel-coated catheter is a safe and related to lower infection rates for high-risk patients who underwent shunt surgery.
分流感染是脑脊液(CSF)分流术的一种严重并发症。具有亲水性表面的导管可能会阻碍细菌黏附,从而减少与导管相关的脑脊液感染。一项回顾性研究比较了使用标准硅橡胶导管或水凝胶涂层脑室导管(Bioglide,美敦力公司)后脑脊液感染的发生率。研究对象为2012年10月至2015年期间在两个中心接受分流手术的神经外科患者。随访期超过数月。该研究共纳入78例患者。其中33例患者使用了35厘米长的水凝胶涂层脑室腹腔分流管(VPS),其余45例患者使用了35厘米长的标准硅橡胶VPS导管。14例(17.9%)患者发生感染,其中6例(7.7%)为明确的与VPS相关的脑脊液感染,其余8例(10.3%)为可能感染。两组患者的总体感染情况存在显著差异[RR(95%CI);0.200(0.050 - 0.803),P = 0.014]。Kaplan - Meier曲线估计分析表明,两种导管类型在感染持续时间上存在显著统计学差异(对数秩=4.204,P < 0.05)。在包括1个月内既往有脑脊液感染(对数秩=4.391,P = 0.04)、外部脑室引流转换为分流(对数秩=4.520,P = 0.03)以及住院时间>1个月(对数秩=5.252,P = 0.02)的亚组中也发现了显著统计学差异。两组1个月内有其他感染的患者之间未发现差异。随访期为36个月。对于接受分流手术的高危患者,水凝胶涂层导管是安全的,且感染率较低。