Vanaclocha V, Sáiz-Sapena N, Leiva J
Division of Neurosurgery, Clinica Universitaria, Pamplona, Navarra, Spain.
Acta Neurochir (Wien). 1996;138(7):829-34. doi: 10.1007/BF01411261.
Ventriculo-peritoneal shunt malfunction may be caused by shunt infection which may not be clinically apparent as the cause of the malfunction by standard diagnostic criteria. This suggests that the real incidence of infected shunts might be higher than previously suspected. In order to study the relationship between infection and shunt malfunction, we followed a protocol over five years (54 V-P shunts) consisting of (1) removal of the malfunctioning shunt and replacement in the same surgical procedure with a new one or institution of an external ventricular drainage for 8 days (if there were clear signs of infection), (2) culturing of CSF and every part of the removed shunt, and (3) intravenous antibiotic treatment (Vancomycin 1g./12h + Ceftriaxone 1g./12h) for five days after the new V-P shunt had been inserted. In those cases in which an external ventricular drainage had been placed, its tip and a portion of the new V-P shunt were also cultured. The results showed that although CSF cultures were negative in 49/54 cases (90.7%), cultures of the removed shunts were positive in 32/54 (59.2%), most of them (21/32, 65.6%) for Staphylococcus coagulase negative organisms. The CSF samples obtained by puncturing the reservoir on admission to Hospital were positive only in 5 out of 54 cases (9.2%), only in those showing clinical features of infection. In the remaining cases, 27 out of 54 (50%) the CSF cultures were negative but the shunt cultures proved positive and required further treatment. For the newly inserted shunts (173) CSF was collected through the shunt during the surgical procedure, and a small piece of the extra-tube from the ventricular and from the peritoneal catheter were obtained and cultured. All the six shunts (6/173, 3.4%) that showed positive cultures after insertion had to be replaced within a period of three to four weeks due to malfunction (range 26 +/- 7 days), indicating that the systematic culture of CSF and tubing helps to predict which shunts will soon need to be replaced due to infection. We conclude that CSF culture alone does not rule out infection in cases of shunt malfunction. The percutaneous CSF obtained from the shunt reservoir admission is particularly prone to show negative cultures even when the shunt is colonized by bacteria.
脑室-腹腔分流术故障可能由分流感染引起，而按照标准诊断标准，这种感染在临床上可能并不表现为故障的原因。这表明感染性分流的实际发生率可能高于先前的推测。为了研究感染与分流故障之间的关系，我们遵循了一项为期五年的方案（54例脑室-腹腔分流术），该方案包括：（1）在同一手术过程中移除故障分流器并更换新的分流器，或者在有明确感染迹象时进行8天的外部脑室引流；（2）对脑脊液和移除的分流器的各个部分进行培养；（3）在插入新的脑室-腹腔分流器后静脉注射抗生素治疗（万古霉素1g/12小时 + 头孢曲松1g/12小时）五天。在放置了外部脑室引流的病例中，还对引流管尖端和新的脑室-腹腔分流器的一部分进行了培养。结果显示，虽然49/54例（90.7%）的脑脊液培养为阴性，但32/54例（59.2%）移除的分流器培养为阳性，其中大多数（21/32，65.6%）为凝固酶阴性葡萄球菌。入院时通过穿刺分流贮液器获得的脑脊液样本仅在54例中的5例（9.2%）呈阳性，且仅在那些有感染临床特征的病例中呈阳性。在其余病例中，54例中有27例（50%）脑脊液培养为阴性，但分流器培养证明为阳性，需要进一步治疗。对于新插入的分流器（173例），在手术过程中通过分流器收集脑脊液，并获取脑室导管和腹腔导管的一小段额外管道进行培养。所有六例（6/173，3.4%）插入后培养呈阳性的分流器由于故障（范围为26±7天）不得不在三到四周内更换，这表明对脑脊液和管道进行系统培养有助于预测哪些分流器由于感染很快需要更换。我们得出结论，仅脑脊液培养不能排除分流故障病例中的感染。即使分流器被细菌定植，从分流贮液器入院时经皮获取的脑脊液特别容易显示培养阴性。
