脑积水临床研究网络质量改进计划：抗生素浸渍导管及万古霉素伤口冲洗的作用
The Hydrocephalus Clinical Research Network quality improvement initiative: the role of antibiotic-impregnated catheters and vancomycin wound irrigation.
作者信息
Chu Jason, Jensen Hailey, Holubkov Richard, Krieger Mark D, Kulkarni Abhaya V, Riva-Cambrin Jay, Rozzelle Curtis J, Limbrick David D, Wellons John C, Browd Samuel R, Whitehead William E, Pollack Ian F, Simon Tamara D, Tamber Mandeep S, Hauptman Jason S, Pindrik Jonathan, Naftel Robert P, McDonald Patrick J, Hankinson Todd C, Jackson Eric M, Rocque Brandon G, Reeder Ron, Drake James M, Kestle John R W
机构信息
1Division of Neurosurgery, Children's Hospital Los Angeles, Department of Neurosurgery, University of Southern California, Los Angeles, California.
2Department of Pediatrics, University of Utah, Salt Lake City, Utah.
出版信息
J Neurosurg Pediatr. 2022 Mar 18;29(6):711-718. doi: 10.3171/2022.2.PEDS2214. Print 2022 Jun 1.
OBJECTIVE
Two previous Hydrocephalus Clinical Research Network (HCRN) studies have demonstrated that compliance with a standardized CSF shunt infection protocol reduces shunt infections. In this third iteration, a simplified protocol consisting of 5 steps was implemented. This analysis provides an updated evaluation of protocol compliance and evaluates modifiable shunt infection risk factors.
METHODS
The new simplified protocol was implemented at HCRN centers on November 1, 2016, for all shunt procedures, excluding external ventricular drains, ventricular reservoirs, and subgaleal shunts. Procedures performed through December 31, 2019, were included (38 months). Compliance with the protocol, use of antibiotic-impregnated catheters (AICs), and other variables of interest were collected at the index operation. Outcome events for a minimum of 6 months postoperatively were recorded. The definition of infection was unchanged from the authors' previous report.
RESULTS
A total of 4913 procedures were performed at 13 HCRN centers. The overall infection rate was 5.1%. Surgeons were compliant with all 5 steps of the protocol in 79.4% of procedures. The infection rate for the protocol alone was 8.1% and dropped to 4.9% when AICs were added. Multivariate analysis identified having ≥ 2 complex chronic conditions (odds ratio [OR] 1.76, 95% confidence interval [CI] 1.26-2.44, p = 0.01) and a history of prior shunt surgery within 12 weeks (OR 1.84, 95% CI 1.37-2.47, p < 0.01) as independent risk factors for shunt infection. The use of AICs (OR 0.70, 95% CI 0.50-0.97, p = 0.05) and vancomycin irrigation (OR 0.36, 95% CI 0.21-0.62, p < 0.01) were identified as independent factors protective against shunt infection.
CONCLUSIONS
The authors report the third iteration of their quality improvement protocol to reduce the risk of shunt infection. Compliance with the protocol was high. These updated data suggest that the incorporation of AICs is an important, modifiable infection prevention measure. Vancomycin irrigation was also identified as a protective factor but requires further study to better understand its role in preventing shunt infection.
目的
脑积水临床研究网络（HCRN）之前的两项研究表明，遵守标准化的脑脊液分流感染方案可降低分流感染率。在第三次迭代中，实施了一个由5个步骤组成的简化方案。本分析提供了方案依从性的最新评估，并评估了可改变的分流感染风险因素。
方法
新的简化方案于2016年11月1日在HCRN中心针对所有分流手术实施，不包括外部脑室引流管、脑室储液器和帽状腱膜下分流术。纳入了截至2019年12月31日进行的手术（38个月）。在初次手术时收集方案依从性、抗生素涂层导管（AIC）的使用情况以及其他感兴趣的变量。记录术后至少6个月的结局事件。感染的定义与作者之前的报告一致。
结果
13个HCRN中心共进行了4913例手术。总体感染率为5.1%。在79.4%的手术中，外科医生遵守了方案的所有5个步骤。仅方案的感染率为8.1%，添加AIC后降至4.9%。多变量分析确定，患有≥2种复杂慢性病（比值比[OR]1.76，95%置信区间[CI]1.26 - 2.44，p = 0.01）以及在12周内有既往分流手术史（OR 1.84，95% CI 1.37 - 2.47，p < 0.01）是分流感染的独立危险因素。使用AIC（OR 0.70，95% CI 0.50 - 0.97，p = 0.05）和万古霉素冲洗（OR 0.36，95% CI 0.21 - 0.62，p < 0.01）被确定为预防分流感染的独立保护因素。
结论
作者报告了他们降低分流感染风险的质量改进方案的第三次迭代。方案依从性较高。这些更新的数据表明，采用AIC是一项重要的、可改变的感染预防措施。万古霉素冲洗也被确定为一个保护因素，但需要进一步研究以更好地了解其在预防分流感染中的作用。
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