Erps Amir, Roth Jonathan, Constantini Shlomi, Lerner-Geva Liat, Grisaru-Soen Galia
Pediatric Infectious Disease Unit, Tel-Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Pediatr Int. 2018 Dec;60(12):1056-1061. doi: 10.1111/ped.13709. Epub 2018 Dec 10.
The aim of this study was to identify independent risk factors for cerebrospinal fluid shunt infection.
The medical records of all patients aged 0-18 years who underwent shunt-related surgery for the treatment of hydrocephalus at the present institution between January 1996 and December 2015 were reviewed. For each case, two randomly selected controls with no shunt infection, matched for year of surgery, were chosen. Demographic clinical and microbiological data were abstracted.
A total of 1,570 shunt-related procedures met the inclusion criteria, yielding 68 infections (in 63 patients). The control group consisted of 132 infection-free patients. The average annual infection rate was 4.2% cases per year. The median time between shunt procedures to infection was 19 days (range, 1-2,181). On multivariate analysis, risk factors associated with increased risk for developing an infection included a history of two or more previous revisions (OR, 4.8; 95%CI: 1.5-15.9); and age <5 years (OR, 4.5; 95%CI 1.5-13.4). A neoplastic etiology for hydrocephalus was found to be a protective factor for shunt infection (P = 0.001).
A history of shunt revision was the most significant risk factor in the development of subsequent shunt infection. Age >5 years was a protective factor. Future efforts should focus on modalities to optimize revision procedures and reduce the risk of subsequent infection.
本研究的目的是确定脑脊液分流感染的独立危险因素。
回顾了1996年1月至2015年12月期间在本机构接受与分流相关手术治疗脑积水的所有0至18岁患者的病历。对于每例病例，选择两名随机抽取的无分流感染且手术年份匹配的对照。提取人口统计学、临床和微生物学数据。
共有1570例与分流相关的手术符合纳入标准，产生68例感染（63例患者）。对照组由132例无感染患者组成。平均年感染率为每年4.2%。分流手术至感染的中位时间为19天（范围1至2181天）。多因素分析显示，与感染风险增加相关的危险因素包括既往有两次或更多次翻修史（OR，4.8；95%CI：1.5至15.9）；以及年龄<5岁（OR，4.5；95%CI 1.5至13.4）。发现脑积水的肿瘤病因是分流感染的保护因素（P = 0.001）。
分流翻修史是随后发生分流感染的最显著危险因素。年龄>5岁是保护因素。未来的努力应集中在优化翻修手术方式并降低后续感染风险上。
