Khalil Fattema, Saemundsson Bjartur, Backlund Alexandra, Frostell Arvid, Arvidsson Lisa
Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.
Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
World Neurosurg. 2024 Dec;192:e402-e409. doi: 10.1016/j.wneu.2024.09.107. Epub 2024 Oct 18.
Hydrocephalus is a common diagnosis worldwide that is treated with shunts and is associated with potential life-threatening risks of shunt dysfunction and infection. We investigated differences in rates of shunt revisions and infections including various factors in patients with different causes of hydrocephalus. We also studied causes of infections and efficacy of perioperative antibiotic regimens. Our objective was to identify patients at risk of higher revision and infection rates after shunt treatment.
We conducted a retrospective single-center cohort study including 728 adult patients who underwent shunt surgery between 2013 and 2019 at our center.
Overall revision rate was 20.1%, and infection rate was 4.8%. Infection was detected in 24% of all revisions. The main location for a positive culture was cerebrospinal fluid (67.5%), frequently caused by Cutibacterium acnes (60%). Younger age and prior shunts were the only predictors confirmed in multivariate Cox regression as significantly increasing the risk of revision surgery. Multivariate Cox regression analysis of infection risk factors showed that obstructive hydrocephalus, prior shunt, and cloxacillin significantly increased risk of shunt infection.
We found revision and infection rates in accordance with other studies. We showed a significantly increased risk in younger patients. Previous shunts also increased the risk of revisions and infections. We showed a small but significant effect of perioperative prophylaxis with broader-spectrum antibiotics compared with cloxacillin. Our study identified a group of younger patients with congenital hydrocephalus and prior implants with an increased risk of shunt infection in whom additional preventive measures should be employed.
脑积水是一种全球常见的诊断疾病，通过分流术进行治疗，且与分流功能障碍和感染等潜在危及生命的风险相关。我们调查了不同病因脑积水患者的分流术翻修率和感染率差异，包括各种因素。我们还研究了感染原因及围手术期抗生素治疗方案的疗效。我们的目的是识别分流治疗后翻修率和感染率较高的风险患者。
我们进行了一项回顾性单中心队列研究，纳入了2013年至2019年在我们中心接受分流手术的728例成年患者。
总体翻修率为20.1%，感染率为4.8%。在所有翻修病例中，24%检测到感染。培养阳性的主要部位是脑脊液（67.5%），常见病原体为痤疮丙酸杆菌（60%）。在多变量Cox回归分析中，年龄较小和既往有分流术是仅有的被证实显著增加翻修手术风险的预测因素。感染危险因素的多变量Cox回归分析显示梗阻性脑积水、既往分流术和氯唑西林显著增加分流感染风险。
我们发现翻修率和感染率与其他研究一致。我们发现年轻患者风险显著增加。既往分流术也增加了翻修和感染风险。与氯唑西林相比，我们发现围手术期使用广谱抗生素预防有小但显著的效果。我们的研究确定了一组先天性脑积水且既往有植入物的年轻患者，其分流感染风险增加，对此应采取额外的预防措施。
