Li Guodong, Pu Ke, Cao YiYao, Wang Jun, Sun ZhiMing, Li QingGuo
Graduate School of Tianjin Medical University, Tianjin, China; Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China.
Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China; Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Disease, Tianjin Neurosurgical Institute, Tianjin, China.
World Neurosurg. 2017 Dec;108:548-554. doi: 10.1016/j.wneu.2017.08.066. Epub 2017 Aug 31.
To determine whether antibiotic prophylaxis (AP) can reduce the postoperative infection rate and identify the risk factors for postoperative infection in shunt surgery.
In this study, we retrospectively collected information for each patient who underwent shunt surgery at Tianjin Huanhu Hospital from January 2011 to December 2016. According to whether prophylactic antibiotics were administered, the cases were divided into antibiotic prophylaxis (AP) and no antibiotic prophylaxis (N-AP) groups to evaluate whether there is a significant difference between the 2 groups. The risk factors for infection after shunt surgery were analyzed with the use of logistic regression analysis to identify independent risk factors.
A total of 570 shunt surgery cases were included. The AP group comprised 321 surgical cases, including 21 cerebrospinal fluid (CSF) shunt infections and 2 incision infections, whereas the N-AP group consisted of 249 surgical cases, including 11 CSF shunt infections and 0 incision infections (P = 0.170). Bacterial cultures indicated that the CSF shunt infections in the AP group included 23 cases, of which 12 (12/23, 52%) were culture-positive, and that the CSF shunt infections in the N-AP group included 11 cases, of which 10 (10/11, 91%) were culture-positive (P = 0.029). There was a significant difference between the group with a time gap <6 months and the group with a time gap ≥6 months (P = 0.038). A logistic regression analysis showed that a history of brain infection (P = 0.032; odds ratio 2.588; 95% confidence interval 1.088-6.158) and previous ventriculostomy (P = 0.049; odds ratio 2.426; 95% confidence interval 1.004-5.866) were independent risk factors for postoperative infection in shunt surgery.
In our study, a preventive effect of AP on postoperative infection was not observed in shunt surgery. However, AP reduced the rate of positive bacterial cultures. A logistic regression analysis demonstrated that a history of brain infection and previous ventriculostomy were independent risk factors for postoperative infection and that AP was a nonprotective factor.
确定预防性使用抗生素（AP）是否能降低分流手术的术后感染率，并识别分流手术术后感染的危险因素。
在本研究中，我们回顾性收集了2011年1月至2016年12月在天津环湖医院接受分流手术的每位患者的信息。根据是否使用预防性抗生素将病例分为预防性使用抗生素（AP）组和未预防性使用抗生素（N-AP）组，以评估两组之间是否存在显著差异。采用逻辑回归分析分流手术后感染的危险因素，以识别独立危险因素。
共纳入570例分流手术病例。AP组包括321例手术病例，其中有21例脑脊液（CSF）分流感染和2例切口感染；而N-AP组包括249例手术病例，其中有11例CSF分流感染且无切口感染（P = 0.170）。细菌培养显示，AP组的CSF分流感染有23例，其中12例（12/23，52%）培养阳性；N-AP组的CSF分流感染有11例，其中10例（10/11，91%）培养阳性（P = 0.029）。时间间隔<6个月的组与时间间隔≥6个月的组之间存在显著差异（P = 0.038）。逻辑回归分析显示，脑感染病史（P = 0.032；比值比2.588；95%置信区间1.088 - 6.158）和既往脑室造瘘术（P = 0.049；比值比2.426；95%置信区间1.004 - 5.866）是分流手术术后感染的独立危险因素。
在我们的研究中，未观察到AP在分流手术中对术后感染有预防作用。然而，AP降低了细菌培养阳性率。逻辑回归分析表明，脑感染病史和既往脑室造瘘术是术后感染的独立危险因素，且AP是一个无保护作用的因素。
