George R, Leibrock L, Epstein M
J Neurosurg. 1979 Dec;51(6):804-11. doi: 10.3171/jns.1979.51.6.0804.
The authors have retrospectively analyzed 840 cerebrospinal fluid shunting procedures over a 25-year period to determine the relationships between infection rates and several possible influences on infection. Two-thirds of all shunt infections occurred within 1 month of surgery. The very young and very old had higher infection rates. Infections became less prevalent over the period of the study, and mortality from infection decreased from 35% to 6%. Successive shunts (revisions) were found to have progressively higher infection rates. Ventriculoatrial and ventriculoperitoneal silicone plastic shunts had similar infection rates (11.4% and 12.0%). The uncontrolled use of prophylactic antibiotics had no effect on shunt infections. Staphylococcus epidermidis became gradually more prevalent over the period of the study, and eventually caused one-half of all infections. Where infection occurred in the presence of prophylaxis, the infectious organism was usually sensitive to the antibiotic being used. The surgeon was found to be the largest single factor in the incidence of shunt infections. A 25-fold variance in infection rates among surgeons could be related to individual experience and technique.
作者回顾性分析了25年间840例脑脊液分流手术，以确定感染率与几种可能影响感染的因素之间的关系。所有分流感染中有三分之二发生在术后1个月内。极年幼和极年老者感染率较高。在研究期间，感染变得不那么普遍，感染导致的死亡率从35%降至6%。发现连续进行的分流手术（翻修术）感染率逐渐升高。脑室心房和脑室腹腔硅胶塑料分流术的感染率相似（分别为11.4%和12.0%）。预防性抗生素的无节制使用对分流感染没有影响。在研究期间，表皮葡萄球菌逐渐变得更为普遍，最终导致了所有感染的一半。在进行预防措施时发生感染的情况下，感染病原体通常对所使用的抗生素敏感。发现外科医生是分流感染发生率中最大的单一因素。外科医生之间25倍的感染率差异可能与个人经验和技术有关。
