Bashir Asma, Sørensen Preben
a Department of Neurosurgery , University Hospital of Aalborg , Hobrovej , Aalborg , Denmark.
Br J Neurosurg. 2017 Aug;31(4):452-458. doi: 10.1080/02688697.2016.1229745. Epub 2016 Sep 14.
We have previously suggested that surgical gloves could be a possible means for transferring microorganisms from skin flora to shunt material during surgery. The objectives of this study were to examine (1) whether the rate of shunt infections was reduced after introducing intraoperative glove change before handling the shunt material; (2) clinical presentation of shunt infections, microbiological data, and treatment management; and (3) predictors of shunt infections.
A retrospective study of 432 shunt operations in 295 adults was undertaken over a 7-year period. Study population consisted of two groups: Group A without intraoperative glove change (2003-2006), and Group B with change of the outer pair of the initial double gloves before handling the shunt material (2006-2009). The results were compared at 6- and 12-month postoperatively. A binary logistic regression was performed to determine predictors of shunt infections.
Overall, 46 (10.6%) infection episodes occurred in 40 (13.6%) patients. Main symptoms were fever, abdominal pain and altered mental status. Propionibacterium acnes was the frequently isolated microorganism, followed by Staphylococcus species. The infection rate was reduced only moderately from 11.8% in Group A to 9.8% in Group B (p = .472). Patients with subarachnoid haemorrhage were more likely to experience shunt infections (17.9%), compared to patients with normal pressure hydrocephalus (5.9%). An increased likelihood of shunt infections for the increased number of subsequent shunt revisions (p = .030) and a trend towards prior history of shunt infections (p = .118) was seen. After adjusting for various covariates, a decreased likelihood of shunt infections for intraoperative glove change was seen at 6-month follow-up for first-time shunt insertion (p = .050).
Intraoperative glove change does not significantly reduce the risk of shunt infection. However, it seems to reduce the infection rate within 6 months in patients undergoing first-time shunt insertion only.
我们之前曾提出，手术手套可能是手术过程中将皮肤菌群中的微生物转移至分流材料的一种途径。本研究的目的是检验：（1）在处理分流材料前更换术中手套后，分流感染率是否降低；（2）分流感染的临床表现、微生物学数据及治疗管理；（3）分流感染的预测因素。
对295例成人患者的432例分流手术进行了为期7年的回顾性研究。研究人群分为两组：A组（2003 - 2006年）术中不更换手套，B组（2006 - 2009年）在处理分流材料前更换最初双层手套的外层手套。术后6个月和12个月时比较结果。进行二元逻辑回归以确定分流感染的预测因素。
总体而言，40例（13.6%）患者发生了46次（10.6%）感染事件。主要症状为发热、腹痛和精神状态改变。痤疮丙酸杆菌是最常分离出的微生物，其次是葡萄球菌属。感染率仅从A组的11.8%适度降低至B组的9.8%（p = 0.472）。与常压性脑积水患者（5.9%）相比，蛛网膜下腔出血患者更易发生分流感染（17.9%）。随着后续分流修正次数增加，分流感染的可能性增加（p = 0.030），且有分流感染既往史的患者有增加趋势（p = 0.118）。在调整各种协变量后，首次分流置入术后6个月随访时，术中更换手套可降低分流感染的可能性（p = 0.050）。
术中更换手套并不能显著降低分流感染风险。然而，似乎仅在首次分流置入的患者中，它能在6个月内降低感染率。
