Multi-center Studies of Pediatric CSF Shunt Infections

描述（由申请人提供）：项目总结：CSF分流道感染极难治疗，导致住院时间延长、重复分流道翻修手术和再感染率高达25%。我们对脑脊液分流道感染的适当治疗的理解是有限的，因此，管理是高度可变的。美国国立卫生研究院（NIH）最近的一次研讨会强调了优化CSF分流感染治疗和预防CSF分流再感染的必要性。作为一名在住院环境中照顾儿童的儿科医生（儿科住院医生），我经常照顾患有CSF分流感染，脑积水和其他神经发育障碍的儿童。本提案的研究和职业发展目标将侧重于进行多中心纵向研究，这对于产生足够的样本量来研究神经发育障碍儿童的临床问题是必要的。拟议项目的核心是脑积水临床研究网络（HCRN），这是一个由慈善基金资助的，在四家儿科神经外科医院之间集中协调的研究工作。我与HCRN的合作为在足够的样本量下进行CSF分流道感染治疗的前瞻性、多中心研究提供了独特的机会。我的职业发展目标包括以下内容：1）扩展我在数据采集和管理方面的现有技能，2）扩展我在研究设计，分析和结果解释方面的现有技能，3）学习如何测量生活质量和心理测量学，以评估神经发育障碍儿童的长期结果，4）学习神经生物学方法，以更好地理解新兴的基础神经科学发现，和5）发展进行多中心研究的专业知识。这些施舍将有助于我的总体职业目标-过渡到一个独立的医生，科学家能够进行严格的多中心研究，需要改善住院医疗保健的证据基础提供给儿童神经发育障碍。 该项目的中心假设是，CSF分流道感染治疗中的医疗和手术决策的变化导致分流道再感染的发生率不同。具体目标包括：1）确定与CSF分流感染相关的患者风险因素，2）确定治疗CSF分流感染的静脉内抗生素持续时间与CSF分流再感染的相关性，3）设计一项多中心随机对照试验，用于治疗HCRN中的CSF分流感染。

DESCRIPTION (provided by applicant): Project Summary: CSF shunt infections are extremely difficult to treat, resulting in prolonged hospitalizations, repeated shunt revision surgeries, and re-infection at rates as high as 25 percent. Our understanding of appropriate treatment of CSF shunt infection is limited and, as a result, management is highly variable. A recent National Institutes of Health (NIH) workshop highlighted a need to optimize treatment of CSF shunt infection and prevent CSF shunt re-Infection. As a pediatrician who cares for children in the inpatient setting (pediatric hospitalist), I frequently care for children with CSF shunt infection, hydrocephalus and other neurodevelopmental disorders. The research and career development aims of this proposal will focus on the conduct of multicenter longitudinal studies, which are necessary to generate adequate sample sizes to study clinical problems in children with neurodevelopmental disorders. Central to the proposed project is the Hydrocephalus Clinical Research Network (HCRN), a philanthropically-funded, centrally coordinated research effort between four pediatric neurosurgical hospitals. My affiliation with the HCRN offers a unique opportunity for a prospective, multicenter study of CSF shunt Infection treatment with adequate sample sizes. My career development aims Include the following: 1) expand my existing skills in data acquisition and management, 2) expand my existing skills In study design, analysis, and interpretation of results, 3) learn how to measure quality of life and psychometrics to assess long-term outcomes for children with neurodevelopmental disorders, 4) learn neurobiology methodologies to better understand emerging basic neuroscience findings, and 5) develop expertise In conducting multicenter studies. These alms will facilitate my overarching career goal- to transition to an independent physician-scientist capable of performing rigorous multicenter studies needed to improve the evidence base of Inpatient health care delivered to children with neurodevelopmental disorders. The central hypothesis of the proposed project is that variation in medical and surgical decision-making in the treatment of CSF shunt infection results in different rates of shunt re-infections. Specific Aims include: 1) Identify patient risk factors associated with CSF shunt infection, and 2) determine the association of intravenous antibiotic duration for treatment of CSF shunt infection with CSF shunt re-infection and 3) design a multicenter randomized controlled trial for the treatment of CSF shunt infection in the HCRN.