因原发性腹部感染入院的脑室腹腔分流患者的中枢神经系统感染：一项美国全国队列分析。

Central Nervous System Infections in Patients With Ventriculoperitoneal Shunts Admitted for Primary Abdominal Infections: A US Nationwide Cohort Analysis.

作者信息

Beaudreault Cameron P, Spirollari Eris, Zeller Sabrina L, Oguguo Odinachi, Wainwright John V, Mohan Avinash, Tobias Michael, Gandhi Chirag D, Al-Mufti Fawaz

机构信息

Department of Neurosurgery, Westchester Medical Center at NY Medical College, Valhalla , New York , USA.

Departments of Neurology, Radiology and Neurosurgery, Westchester Medical Center at NY Medical College, Valhalla , New York , USA.

出版信息

Neurosurgery. 2025 Apr 1;96(4):794-801. doi: 10.1227/neu.0000000000003156. Epub 2024 Sep 9.

DOI:10.1227/neu.0000000000003156

PMID:39248516

Abstract

BACKGROUND AND OBJECTIVES

Although ventriculoperitoneal (VP) shunts are a common treatment for hydrocephalus, there are complication risks including infections. Late complications such as ventriculitis from ascending abdominal infections can have severe consequences. However, the incidence of central nervous system (CNS) infections in VP shunt patients with abdominal infections is not well understood. We aimed to determine the incidence of CNS infections in VP shunt patients admitted with abdominal infections.

METHODS

Using the National Inpatient Sample, we studied patients from 2016 to 2019 to determine the incidence of CNS infections in VP shunt patients admitted with abdominal infections. Results were compared with VP shunt patients admitted for primary pneumonia.

RESULTS

Among 725 VP shunt patients presenting with abdominal infections, 20 (2.8%) had CNS infections. Chronic obstructive pulmonary disease, hypertension, older age, and a smoking history were more common in patients with CNS infections and primary abdominal infection ( P < .05). Patients who developed CNS infection had a significantly higher likelihood of both blood transfusion and coma but a lower likelihood of seizures. VP shunt patients with CNS infections were more likely to undergo shunt removal (odds ratio [OR] = 23.167, P < .001). 4.1% of VP shunt patients with primary abdominal infections died during admission. In a population of primary abdominal infection and pneumonia patients with VP shunts, a multivariate logistic regression analysis controlling for age, sex, and comorbidities identified abdominal infection as an independent risk factor for both CNS infection (OR = 51.208, P < .001) and inpatient death (OR = 3.417, P < .001). Among 6620 VP shunt patients admitted with primary pneumonia, only 5 (0.1%) had CNS infection compared with 20 (2.8%) in those with a primary abdominal infection (OR = 37.532, P < .001), and mortality was 1.6% vs 4.1% for those with a primary abdominal infection ( P < .05).

CONCLUSION

CNS infections in VP-shunted patients with abdominal infections are relatively rare but may lead to increased risks of death and other serious adverse outcomes.

摘要

背景与目的

尽管脑室腹腔（VP）分流术是治疗脑积水的常用方法，但存在包括感染在内的并发症风险。诸如因腹部感染上行导致的脑室炎等晚期并发症可能会产生严重后果。然而，VP分流术患者发生腹部感染时中枢神经系统（CNS）感染的发生率尚不清楚。我们旨在确定因腹部感染入院的VP分流术患者中CNS感染的发生率。

方法

利用国家住院患者样本，我们研究了2016年至2019年的患者，以确定因腹部感染入院的VP分流术患者中CNS感染的发生率。将结果与因原发性肺炎入院的VP分流术患者进行比较。

结果

在725例出现腹部感染的VP分流术患者中，20例（2.8%）发生了CNS感染。慢性阻塞性肺疾病、高血压、高龄和吸烟史在发生CNS感染和原发性腹部感染的患者中更为常见（P<.05）。发生CNS感染的患者输血和昏迷的可能性显著更高，但癫痫发作的可能性较低。发生CNS感染的VP分流术患者更有可能接受分流管移除（优势比[OR]=23.167，P<.001）。4.1%的原发性腹部感染的VP分流术患者在住院期间死亡。在一组原发性腹部感染和肺炎的VP分流术患者中，一项控制年龄、性别和合并症的多因素逻辑回归分析确定腹部感染是CNS感染（OR=51.208，P<.001）和住院死亡（OR=3.417，P<.001）的独立危险因素。在6620例因原发性肺炎入院的VP分流术患者中，只有5例（0.1%）发生了CNS感染，而原发性腹部感染患者中有20例（2.8%）发生了CNS感染（OR=37.532，P<.001），原发性腹部感染患者的死亡率为4.1%，而原发性肺炎患者的死亡率为1.6%（P<.05）。