Cerebrospinal fluid shunt infections in children over a 13-year period:: anaerobic cultures and comparison of clinical signs of infection with Propionibacterium acnes and with other bacteria
Cerebrospinal fluid shunt infections in children over a 13-year period:: anaerobic cultures and comparison of clinical signs of infection with Propionibacterium acnes and with other bacteria
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DOI：
10.3171/ped/2008/1/5/366
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发表时间：
2008-05-01
影响因子：
1.9
通讯作者：
Sjolin, Jan
中科院分区：
文献类型：
--
作者：
Arnell, Kai;Cesarini, Kristina;Sjolin, Jan
Object.分流感染是一个主要问题，有后遗症甚至死亡的风险。本回顾性研究的目的是分析分流道感染的发生率、起源和临床表现，特别是除了常规检查外，还进行厌氧微生物培养的结果、延长的孵育时间和痤疮丙酸杆菌引起的感染。回顾性分析了乌普萨拉大学医院13年间由小儿外科医生实施手术的237例脑积水患儿（年龄范围0-15岁）的病历。474例手术后发生34例经证实或怀疑的脑室内分流管感染和5例远端导管感染。皮肤细菌，如凝固酶阴性葡萄球菌（[CoNS]，19例患者）、金黄色葡萄球菌（7例患者）和痤疮丙酸杆菌（6例患者）占优势。添加厌氧培养物和延长孵育时间使分流感染的验证增加了三分之一以上。痤疮丙酸杆菌感染的儿童年龄较大，体温较低，脑脊液（CSF）白细胞较少，CSF/血糖较高。比率，更多的远端导管感染和其他感染源。4例有腹部假性囊肿。感染CoNS的1岁以下儿童比有全身和局部症状的年龄较大的儿童受影响更大。在远端导管和瓣膜置换术时发生远端导管感染和丙酸杆菌生长的儿童中，不需要后续抗生素治疗。添加厌氧培养物和延长孵育时间导致分流道感染的检出率增加。丙酸杆菌引起的感染通常会导致轻微的症状，如果没有获得足够的厌氧培养，这些症状可能会被忽视。
Object. Shunt infections represent a major problem with risk for sequelae and even death. The aim in this retrospective Study was to analyze the incidence, origin, and clinical presentation of shunt infections, with special reference to the results of cultures for anaerobic organisms performed in addition to the usual tests, to prolonged incubation times, and to infections caused by Propionibacterium acnes.Methods. The medical records of 237 hydrocephalic children (age range 0-15 years) in whom operations were performed by a pediatric surgeon at Uppsala University Hospital during a 13-year period were reviewed.Results. Thirty-four verified or suspected intraventricular shunt infections and 5 distal catheter infections occurred after 474 operations. Skin bacteria, such as coagulase-negative staphylococci ([CoNS], 19 patients), Staphylococcus aureus (7 patients), and P. acnes (6 patients) predominated. The addition of anaerobic cultures and prolonged incubation times increased the verification of shunt infection by more than one third. Children with P. acnes infection were significantly older, had a lower body temperature, fewer cerebrospinal fluid (CSF) leukocytes, a higher CSF/blood glucose. ratio, more distal catheter infections, and other sources of infection. Four had an abdominal pseudocyst. Children < 1 year of age and infected with CoNS were more affected than older children with systemic and local symptoms. In children with distal catheter infection and growth of propionibacteria at the time of the distal catheter and valve replacement, no follow-up antibiotic treatment was necessary.Conclusions. Addition of anaerobic cultures and prolonged incubation times led to an increase in the detection of shunt infections. Infections caused by propionibacteria often result in mild symptoms that may be overlooked if adequate anaerobic Cultures are not obtained.