From the Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
Pediatr Infect Dis J. 2022 Jun 1;41(6):449-454. doi: 10.1097/INF.0000000000003513. Epub 2022 May 6.
Infections complicate 5%-10% of cerebrospinal fluid (CSF) shunts. We aimed to describe the characteristics and contemporary pathogens of shunt infections in children in Canada and the United States.
Descriptive case series at tertiary care hospitals in Canada (N = 8) and the United States (N = 3) of children up to 18 years of age with CSF shunt infections from July 1, 2013, through June 30, 2019.
There were 154 children (43% female, median age 2.7 years, 50% premature) with ≥1 CSF shunt infections. Median time between shunt placement and infection was 54 days (interquartile range, 24 days-2.3 years). Common pathogens were coagulase-negative staphylococci (N = 42; 28%), methicillin-susceptible Staphylococcus aureus (N = 24; 16%), methicillin-resistant S. aureus (N = 9; 5.9%), Pseudomonas aeruginosa (N = 9; 5.9%) and other Gram-negative bacilli (N = 14; 9.0%). Significant differences between pathogens were observed, including timing of infection (P = 0.023) and CSF leukocyte count (P = 0.0019); however, differences were not sufficient to reliably predict the causative organism based on the timing of infection or discriminate P. aeruginosa from other pathogens based on clinical features. Empiric antibiotic regimens, which included vancomycin (71%), cefotaxime or ceftriaxone (29%) and antipseudomonal beta-lactams (33%), were discordant with the pathogen isolated in five cases. There was variability between sites in the distribution of pathogens and choice of empiric antibiotics. Nine children died; 4 (44%) deaths were attributed to shunt infection.
Staphylococci remain the most common cause of CSF shunt infections, although antibiotic resistant Gram-negative bacilli occur and cannot be reliably predicted based on clinical characteristics.
感染使 5%-10%的脑脊髓液（CSF）分流复杂化。我们旨在描述加拿大和美国儿童 CSF 分流感染的特征和当代病原体。
2013 年 7 月 1 日至 2019 年 6 月 30 日，在加拿大（N=8）和美国（N=3）的三级保健医院进行了描述性病例系列研究，纳入年龄在 18 岁以下的 CSF 分流感染患儿。
共有 154 名（43%为女性，中位年龄 2.7 岁，50%为早产儿）患儿发生了≥1 次 CSF 分流感染。分流放置与感染之间的中位时间为 54 天（四分位距，24 天-2.3 年）。常见病原体为凝固酶阴性葡萄球菌（N=42；28%）、甲氧西林敏感金黄色葡萄球菌（N=24；16%）、甲氧西林耐药金黄色葡萄球菌（N=9；5.9%）、铜绿假单胞菌（N=9；5.9%）和其他革兰氏阴性杆菌（N=14；9.0%）。观察到病原体之间存在显著差异，包括感染时间（P=0.023）和 CSF 白细胞计数（P=0.0019）；然而，这些差异不足以根据感染时间可靠地预测致病病原体，也不足以根据临床特征区分铜绿假单胞菌与其他病原体。经验性抗生素方案包括万古霉素（71%）、头孢噻肟或头孢曲松（29%）和抗假单胞菌β-内酰胺类（33%），在五例病例中与分离出的病原体不符。各部位病原体分布和经验性抗生素选择存在差异。9 名患儿死亡；4（44%）例死亡归因于分流感染。
葡萄球菌仍然是 CSF 分流感染的最常见原因，尽管出现了抗生素耐药的革兰氏阴性杆菌，但根据临床特征无法可靠预测。
