1984 Geraghty 1986 Mollman 1986 Shapiro 1987 Young

干净神经外科手术后感染率 对照研究 感染率(%) 1984 Geraghty 1986 Mollman 1986 Shapiro 1987 Young 1988 Blomstedt 有预防性用 药 0. 5 NA 2. 8 1. 0 1. 8 无预防性用 药 3. 6 NA 11. 7 3. 8 7. 4 相对风险 (RR) 7. 4 5. 6 4. 1 3. 9 4. 1 Neurosurgery 1989; 24: 401 -5 2021/10/30

Clin Infect Dis 2008: 47: 73 -82

Conen et al. , Clin Infect Dis 2008: 47: 73 -82

Conen et al. , Clin Infect Dis 2008: 47: 73 -82

Factors contributing to the Medical Costs of Cerebrospinal Fluid Shunt Infection Treatment in Pediatric Patients with Standard Shunt Components Compared with Antibiotic-impregnated Components • • • 回溯型研究 1 -16岁的儿科病人因水脑而置放中枢神经导管 3年以上者 病人术后随访 12个月 N = 211病人共经历353次导管植入手术 男: 女 195: 158, 55%: 45% 导管型态 – VP 326 (92%), VPL 17 (5%), VA 10 (3%) • 病人分组发现：较年轻, 较多早产, 较多脑出血, 较常用程 序化瓣膜(programmable valves) Neurosurg Focus 2007; 22: E 9

211 patients had 353 shunting procedures; 208 standard shunts, 145 AISs (if full system, clindamycin and rifampicin) After adjusting for intercohort differences, on multivariate analysis, AIS catheters were independently associated with a 2. 4 -fold decreased likelihoood of shunt infection (relative risk = 0, 041, 95% CI 0. 32 -0. 52, p<0. 01 Sciubba DM et al, Factors contributing to the Medical Costs of Cerebrospinal Fluid Shunt Infection Treatment in Pediatric Patients with Standard Shunt Components Compared with Antibioticimpregnated Components Neurosurg Focus 2007; 22: E 9

Treatment and Microbiology of Repeated CSF Shunt Infections in Children University of California at San Francisco 31名第二度导管感染者 (SI-2) 81%第一次置放导管在 <6个月大时 男性 77% 脑室腹腔导管占 71% 18名接受 SI-3 (60%), 8名接受SI-4 (47%) 到SI-3的平均时间为 477天 (范围 2 -828 天), 到 SI-4的平均时间为 2137天 (范围 9 -2137天) • 病原菌以格兰氏阳性菌为主 (SI-2 93%, SI-3 94%) • • • “SI-2的孩童有较高的后续再感染率及较长的感染间隔” Ped Inf Dis J 2011; 30 731 -735

干净无植入物开颅手术 Infection in Neurosurgery Working Party of the British Society for Antimicrobial Chemotherapy, Antimicrobial prophylaxis in neurosurgery and after head injury Lancet 1994; 344: 1547 -51 cefazolin 1 -2 G iv single dose alternative vancomycin 1 g iv single dose

干净污染开颅手术 • Clean, contaminated (through sinuses or oro/nasopharynx) • clindamycin 900 mg iv single dose, or amoxicillin-clavulinic acid 1. 2 g single dose or cefuroxime 1. 5 g iv single dose plus metrondidazole 500 mg iv single dose

CSF Shunt Insertion • Meta-analysis suggests benefit of prophylaxis (Cochrane Database 3: CD 005365, 2006) • Cefazolin 1 -2 g iv single dose, alternative vancomycin 1 g iv single dose • In a hospital with a high prevalence of MRSA infection, vancomycin was more effective (J Hosp Infect 2008; 69: 337

Quality Improvement/”Care Bundle”

Management of Infection

建议脑室内注射的抗微生物制剂 (A-III) Allan R. Tunkel et al. Clin Infect Dis. 2004; 39: 1267 -1284 © 2004 by the Infectious Diseases Society of America