脑脊液分流感染患儿中致病微生物与感染时间的关系。

Relationship of causative organism and time to infection among children with cerebrospinal fluid shunt infection.

作者信息

Test Matthew R, Whitlock Kathryn B, Langley Marcie, Riva-Cambrin Jay, Kestle John R W, Simon Tamara D

机构信息

1Department of Pediatrics, University of Washington/Seattle Children's Hospital.

2Seattle Children's Hospital Research Institute, Seattle, Washington.

出版信息

J Neurosurg Pediatr. 2019 Jul 1;24(1):22-28. doi: 10.3171/2019.2.PEDS18638. Epub 2019 May 3.

DOI:10.3171/2019.2.PEDS18638

PMID:31051463

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6928433/

Abstract

OBJECTIVE

Infection is a common complication of cerebrospinal fluid (CSF) shunts, occurring in 6%-20% of children. Although studies are limited, Staphylococcus aureus is thought to cause more rapid and aggressive infection than coagulase-negative Staphylococcus (CONS) or gram-negative organisms. The authors' objective was to evaluate the relationship between the causative organisms of CSF shunt infection and the timing of infection.

METHODS

The authors performed a retrospective cohort study of children who underwent CSF shunt placement at a tertiary care children's hospital over a 9-year period and subsequently developed a CSF shunt infection. The primary predictor variable was the causative organism recovered from CSF culture, characterized as S. aureus, CONS, or gram-negative organisms. The primary outcome was time to infection, defined as the number of days from most recent shunt intervention to the diagnosis of the infection. The association between causative organism and time to infection was visualized using Kaplan-Meier curves, and statistical comparisons were made using nonparametric Kruskal-Wallis tests.

RESULTS

Among 103 children in whom a CSF shunt infection developed, the causative organism was CONS in 57 (55%), S. aureus in 19 (18%), and gram-negative organisms in 9 (9%). The median time to infection did not differ (p = 0.81) for infections caused by CONS (20 days, IQR 11-40), S. aureus (26 days, IQR 12-95), and gram-negative organisms (23 days, IQR 17-34).

CONCLUSIONS

No significant difference in time to infection based on the causative organism was observed among children with a CSF shunt infection.

摘要

目的

感染是脑脊液（CSF）分流术的常见并发症，在6% - 20%的儿童中发生。尽管研究有限，但据认为金黄色葡萄球菌比凝固酶阴性葡萄球菌（CONS）或革兰氏阴性菌引起的感染更迅速且更具侵袭性。作者的目的是评估CSF分流感染的病原体与感染时间之间的关系。

方法

作者对一家三级儿童专科医院9年间接受CSF分流置管并随后发生CSF分流感染的儿童进行了一项回顾性队列研究。主要预测变量是从CSF培养中分离出的病原体，分为金黄色葡萄球菌、CONS或革兰氏阴性菌。主要结局是感染时间，定义为从最近一次分流干预到感染诊断的天数。使用Kaplan-Meier曲线直观显示病原体与感染时间之间的关联，并使用非参数Kruskal-Wallis检验进行统计学比较。

结果

在103例发生CSF分流感染的儿童中，病原体为CONS的有57例（55%），金黄色葡萄球菌的有19例（18%），革兰氏阴性菌的有9例（9%）。CONS引起的感染（20天，四分位间距11 - 40）、金黄色葡萄球菌引起的感染（26天，四分位间距12 - 95）和革兰氏阴性菌引起的感染（23天，四分位间距17 - 34）的感染中位时间无差异（p = 0.81）。