Infectious Diseases Department, Hospital Universitari de Bellvitge-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain.
Unit of Infectious Diseases, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain.
Clin Infect Dis. 2017 Apr 15;64(8):989-997. doi: 10.1093/cid/cix005.
Little is known regarding the optimal treatment of ventriculoperitoneal (VP) shunt infections in adults. Our aim was to assess the efficacy of treatment strategies and to identify factors that predict failure.
Retrospective, observational study of patients aged ≥12 years with VP shunt infections (1980 -2014). Therapeutic approaches were classified under 4 headings: only antibiotics (OA), one-stage shunt replacement (OSSR), two-stage shunt replacement (TSSR), and shunt removal without replacement (SR). The primary endpoint was failure of the treatment strategy, defined as the absence of definite cerebrospinal fluid (CSF) sterilization or related mortality. The parameters that predicted failure were analyzed using logistic regression.
Of 108 episodes (51% male, median age 50 years), 86 were analyzed. Intravenous antibiotics were administered for a median of 19 days. Eighty episodes were treated using strategies that combined antibiotic and surgical treatment (37 TSSR, 24 SR, 19 OSSR) and 6 with OA. Failure occurred in 30% of episodes, mostly due to lack of CSF sterilization in OSSR and OA groups. Twelve percent died of related causes and 10% presented superinfection of the CSF temporary drainage/externalized peritoneal catheter. TSSR was the most effective strategy when VP shunt replacement was attempted. The only independent risk factor that predicted failure was retention of the VP shunt, regardless of the strategy.
This is the largest series of VP shunt infections in adults reported to date. VP shunt removal, particularly TSSR when the patient is shunt dependent, remains the optimal choice of treatment and does not increase morbidity.
成人脑室-腹腔（VP）分流感染的最佳治疗方法知之甚少。我们的目的是评估治疗策略的疗效，并确定预测失败的因素。
这是一项回顾性、观察性研究，纳入 1980 年至 2014 年期间年龄≥12 岁的 VP 分流感染患者。治疗方法分为 4 类：仅使用抗生素（OA）、一期分流置换（OSSR）、二期分流置换（TSSR）和分流移除而不置换（SR）。主要终点是治疗策略的失败，定义为没有明确的脑脊液（CSF）灭菌或相关死亡率。使用逻辑回归分析预测失败的参数。
共 108 例（51%为男性，中位年龄 50 岁），86 例被纳入分析。静脉使用抗生素的中位时间为 19 天。80 例采用抗生素联合手术治疗（37 例 TSSR、24 例 SR、19 例 OSSR），6 例采用 OA。30%的患者发生治疗失败，主要是由于 OSSR 和 OA 组的 CSF 灭菌失败。12%的患者因相关原因死亡，10%的患者出现 CSF 临时引流/外置腹腔导管的再次感染。当尝试 VP 分流置换时，TSSR 是最有效的策略。唯一独立的预测失败的风险因素是 VP 分流的保留，无论采用何种策略。
这是迄今为止报告的最大型成人 VP 分流感染系列研究。VP 分流移除，特别是当患者依赖分流时进行 TSSR，仍然是最佳的治疗选择，不会增加发病率。
