Department of infectious and tropical diseases, CHRU Besançon, Besançon, France.
Laboratory of microbiology, CHRU Besançon, Besançon, France.
Infect Dis Now. 2023 Apr;53(3):104665. doi: 10.1016/j.idnow.2023.104665. Epub 2023 Feb 2.
Data on infections associated with cerebrospinal fluid shunt (CSF-S) or device-associated infection (CSF-SDI) are limited in adults. We performed a retrospective study to describe characteristics, management, and outcome of CSF-SDI.
All patients with CSF-SDI and admitted to our institution from January 2013 to December 2019 were included.
Among 50 patients, fifty-six episodes of CSF-SDI (41 external ventricular device-associated infections (CSF-D) and 15 other shunt infections (CSF-S) were included. The incidence of CSF-SDI was 11.9 %. Fever was the most common symptom (81 %). Enterobacterales were more prevalent in CSF-S than in CSF-D (20 % vs 53 %, p = 0.02). As regards CSF-D, deceased patients (11/41, 27 %) more frequently had a Glasgow coma scale score decreasing from baseline (p < 0.01), lower glycorrhachia (p < 0.01), a higher protein level in CSF (p = 0.001) and a positive control CSF culture (p = 0.031).
CSF-SDIs are rare but with a high mortality rate. Mortality was more closely related to the infection than to comorbidities or underlying neurosurgical disease. A second CSF analysis significantly helped to detect patients with CSF-D with a poor prognosis.
有关与脑脊髓液分流（CSF-S）或器械相关感染（CSF-SDI）相关感染的数据在成人中有限。我们进行了一项回顾性研究，以描述 CSF-SDI 的特征、治疗和结果。
纳入 2013 年 1 月至 2019 年 12 月期间在我院住院的所有 CSF-SDI 患者。
在 50 例患者中，共 56 例 CSF-SDI 患者（41 例为外部脑室引流装置相关感染（CSF-D），15 例为其他分流感染（CSF-S））。CSF-SDI 的发生率为 11.9%。发热是最常见的症状（81%）。CSF-S 中肠杆菌科的发生率高于 CSF-D（20% vs 53%，p=0.02）。在 CSF-D 中，死亡患者（41 例中的 11 例，27%）更常出现格拉斯哥昏迷评分较基线下降（p<0.01），糖脑积液较低（p<0.01），CSF 中蛋白水平较高（p=0.001），CSF 培养阳性（p=0.031）。
CSF-SDI 虽然罕见，但死亡率很高。死亡率与感染的关系比合并症或潜在的神经外科疾病更为密切。第二次 CSF 分析有助于发现预后较差的 CSF-D 患者。
