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  • 學位論文

腦脊髓液分流感染:危險因子及預後

Cerebrospinal fluid shunt infection: risk factors and outcome

指導教授 : 周明智

摘要


研究目的:大約10%的腦脊髓液(CSF)分流手術與病患感染有關,需要將內引流管外拉或置放腦室外引流管將腦脊髓液引流至體外。住院治療中使用抗生素,待腦脊髓液感染治療乾淨後置入新的分流裝置。本文將分析腦脊髓液分流感染其細菌種類的分佈,並分析造成腦脊髓液分流感染的危險因子和預後。 研究方法及資料:從2006年1月至2010年6月,對病患進行回顧性評估。共有350名病患納入研究,這些病患都是曾經有放置腦脊髓液分流的病患。通過腦脊髓液標本培養來證實的分流感染病患。腦脊髓液分流感染後,我們將對病患進行追蹤1年。所有感染的病患均獲得經驗性抗生素治療。 研究結果: 在研究期間觀察到17例通過腦脊髓液標本培養證實分流感染的病患(5%)。治療後再感染的有1例(5.9%)且是由同一生物體(表皮葡萄球菌)引起。最常見的2種細菌是金黃色葡萄球菌和表皮葡萄球菌,均各有4例(23.5%)。神經外科手術後造成中樞神經系統感染而引起水腦症的病患治療後造成分流感染的發生率高(調整後優勢比為11.65; 95%信賴區間,2.43∼55.75,p = 0.002),佔所有分流感染病患的23.5%(p = 0.001)。 47%的分流感染病患處於免疫功能不全狀態,但並無統計學上意義(p = 0.437)。死亡率為17.6%,所有死亡人數均發生在老年人身上。腦脊髓液分流感染組預後較差(GOS 1-3)的病患佔76.5%,但與年齡無顯著差異(p = 0.113)。 結論與建議:神經外科手術後造成中樞神經系統感染而引起水腦症的病患治療後造成分流感染有統計學上意義。因此,在手術前使用較後線抗生素也許可以降低感染的發生,但未來仍須更多的證據來證實。另一方面,以下三點和感染之間沒有統計學上差異關係:1)病患免疫功能不全狀態;2)無論患者是否處於免疫功能不全狀態,分流感染病患中的感染細菌分佈情況; 3)年齡和預後較差的關係。

關鍵字

水腦症 分流感染 危險因子 預後

並列摘要


Objective:Approximately 10% of cerebrospinal fluid(CSF) shunt operations are associated with infection and require the removal or externalization of the shunt, in-hospital treatment with antibiotic agents, and insertion of a new shunt. We analyze the distribution of organisms, the risk factors and outcome of CSF shunt infection. Methods and Materials:From January 2006 to June 2010, patients were retrospectively evaluated. 350 patients were enrolled in the study if they had a CSF shunt placement. Patients with shunt infection proven by culture of a CSF specimen were enrolled. Patients from our center were followed up for 1 year after their CSF shunt infection. All patients were provided empirical antibiotic therapy. Results:17 patients (5%) with shunt infection proven by culture of a CSF specimen were observed during the study period. Reinfection occurred in 1 patient (5.9%) and caused by the same organism (Staphylococcus epidermidis). The most 2 common organisms were Staphylococcus aureus and Staphylococcus epidermidis both occurring in 4 patients (23.5%). There was a high incidence of shunt infection after treatment of neurosurgical procedures related to CNS infection (adjusted odds ratio, 11.65; 95% confidence interval, 2.43-55.75, p=0.002) and the overall infectious rate was 23.5% (p = 0.001). Fourty seven percent of our shunt infectious patients were in an immunocompromised status, but there were no statistically significant difference (p = 0.437). The mortality rate was 17.6% and all fatalities occurred in older adults. 76.5% of the patients in the CSF shunt infected group had a poor outcome (GOS 1–3), but there were no significant differences with regards to age (p = 0.113). Conclusion and Suggestion:A statistically significant relationship was observed between shunt infection and the neurosurgical procedures related to CNS infection. On the other hand, no statistically significant relationships have been found between infection and 1) immunocompromised status; 2) distribution of organisms in shunt infection in patients whether or not they are in an immunocompromised status; 3) poor outcome with regards to age.

並列關鍵字

Hydrocephalus Shunt infection Risk factors Outcome

參考文獻


1. Patwardhan RV, Nanda A. 2005. Implanted ventricular shunts in the United States: the billion-dollar-a-year cost of hydrocephalus treatment. Neurosurgery 56(1):139-144, discussion 144-145.
2. Cabezudo JM, Olabe J, Bacci F. 1990. Infection of intervenebral displace after placement of percutaneous lumboperitoneal for benign intracranial hypertention. Neurosurgery 26(6):1005-1009.
3. Kesde J, Drake J, Milner R, et al. 2000. Long term follow up data from the Shunt Design Tria1. Ped Neurosurg 33(5):230.
4. Drake JM, Kestle JR, Milner R, Cinalli G, Boop F, Piatt J Jr, et al. 1998. Randomized trial of cerebrospinal fluid shunt valve design in pediatric hydrocephalus. Neurosurgery 43:294-305.
5. Kestle J, Drake J, Milner R, Sainte-Rose C, Cinalli G, Boop F, et al. 2000. Long-term follow-up data from the Shunt Design Trial. Pediatr Neurosurg 33:230-236.

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