脑室-腹腔分流术初次感染后再感染原因分析

The causes of reinfection following initial ventriculoperitoneal shunt infection

目的探讨脑室-腹腔分流术(VP)初次感染后再感染的原因及处理。方法回顾性分析2007年2月1日至2012年2月1日苏州大学附属第一人民医院神经外科海泰电子病历系统V1.0中记录有脑室-腹腔分流术患者的病例资料及分流管感染情况。结果 372例行脑室-腹腔分流术患者,初次感染24人,5例再感染。初次感染后的处理:拨除引流管21人,其中拔管后不再重新置管3人,无再感染,拔管后外引流至脑脊液正常后再置管18人,2例发生再感染,初次感染后不拔管应用抗生素及对症治疗2人,部分拔管改脑脊液外引流后再置分流管1人,均发生再感染。结论脑室-腹腔分流术后初次感染立即拔除引流管并全身应用抗生素,是最佳的治疗方案,初次感染后不拔管或部分拔管的治疗无法控制感染。

Objective To explore the causes and treatments of reinfection following initial ventriculoperitoneal （VP） shunt iniection. Methods Retrospective analysis the medical records that refer to VP shunt and shunt infection in hydratight electronic medical record system in the Version 1.0 of The First Affiliated Hospital of Soochow University from February 1,2007 to February 1, 2012. Results Among 372 patients with VP shunt,24 cases with initial VP shunt infection, of which 5 cases of reinfection. The treatments of initial shunt infection were as filows： 21 cases had removed the shunt, of which 3 cases were complete shunt removal without shunt replace- ment, none of reinfection, while the other 18 cases who were shunt removal and external drainage followed by new shunt placement once the CSF is sterile, of 2 cases reinfection ; 2 cases were only antimicrobial and symptomatic treatment without shunt removal and 1 case was a part of shunt removal（ the distal portion of the shunt device）followed by external drainage followed by new shunt placement（ 1 case） ,of all 3 cases reinfection. Conclusions The most effective treatment of initial ventriculoperitoneal shunt infection was immediately shunt removal in combination with appropriate systemic antibiotics. Partial or without shunt removal after initial VP shunt infection can＇ t control the infection.