Neurosurgery Division, Department of Surgery, University Of Zimbabwe, Harare, Zimbabwe.
Neurosurgery Division, Department of Surgery, University Of Bamenda, Bamenda, Cameroon.
Childs Nerv Syst. 2020 Feb;36(2):401-409. doi: 10.1007/s00381-019-04357-z. Epub 2019 Aug 27.
Shunting for hydrocephalus can lead to improvement in the quality of life although the latter has been subdued by complications like shunt infection. Established protocols have contributed to the reduction of ventriculoperitoneal shunt (VPS) infections. Previously, we retrospectively demonstrated a low infection rate despite some of the protocol recommendations not being implemented. The aim of this study was to prospectively establish the incidence of shunt infection in the early post-shunt period following our protocol and elucidate on associated risk factors.
A multicenter prospective descriptive cohort study of consecutive 209 under-5 children requiring VPS for hydrocephalus was conducted between January 2013 and November 2018. An innovative protocol insisting on intermittent application of povidone-iodine on the skin during the operation was implemented. The patients were followed-up for 3 months post-surgery.
Included were 211 VPS procedures performed on 209 children. The median age was 9 months and 84 were males. Hydrocephalus was non-communicative in 72.0% and aqueductal stenosis was its most frequent cause (84.9%). Most surgeries were performed in the morning (90.5%), electively (95.3%), and for the first time (91%). The median duration of surgery was 65 min. Shunt infection rate was 1.9% (n = 4) (95% CI 0.7 to 5.0%) per procedure.
The observed infection rate was low. This suggests that the protocol followed captured the most critical components necessary to ensure low infection rates and that simple measures implemented in economically challenged environments may achieve internationally acceptable infection rates.
尽管分流感染等并发症削弱了分流术对脑积水的疗效，但分流术仍可提高生活质量。既定的方案有助于降低脑室腹腔分流（VPS）感染率。此前，我们回顾性研究显示，尽管没有完全遵循方案建议，但感染率仍较低。本研究旨在前瞻性评估我们方案下早期 VPS 后分流感染的发生率，并阐明相关的危险因素。
这是一项多中心前瞻性描述性队列研究，纳入了 2013 年 1 月至 2018 年 11 月期间因脑积水需要 VPS 的 209 例 5 岁以下儿童。方案中创新性地坚持在手术过程中间歇性使用聚维酮碘对皮肤进行消毒。术后对患者进行 3 个月的随访。
共进行了 211 次 VPS 手术，涉及 209 例患儿。中位年龄为 9 个月，84 例为男性。72.0%的脑积水为非交通性，最常见的病因是导水管狭窄（84.9%）。大多数手术在上午（90.5%）、择期（95.3%）和首次手术（91%）进行。中位手术时间为 65 分钟。分流感染率为 1.9%（n=4）（95%CI 0.7 至 5.0%）/手术。
观察到的感染率较低。这表明所遵循的方案抓住了确保低感染率的最关键因素，在经济困难的环境中实施简单的措施可能达到国际上可接受的感染率。
