BACKGROUND Infection prevention techniques used during cerebrospinal fluid (CSF) shunt surgery include: (1) standard perioperative intravenous antibiotics, (2) intrathecal (IT) antibiotics, (3) antibiotic-impregnated catheter (AIC) shunt tubing, or (4) Both IT and AIC. These techniques have not been assessed against one another for their impact on the infecting organisms and patterns of antimicrobial resistance. METHODS We performed a retrospective longitudinal observational cohort study of children with initial CSF shunt placement between January 2007 and December 2012 at 6 US hospitals. Data were collected electronically from the Pediatric Health Information Systems+ (PHIS+) database, and augmented with standardized chart review. Only subjects with positive CSF cultures were included in this study. RESULTS Of 1,723 children whose initial shunt placement occurred during the study period, 196 (11%) developed infection, with 157 (80%) having positive CSF cultures. Of these 157 subjects, 69 (44%) received standard care, 28 (18%) received AIC, 55 (35%) received IT antibiotics, and 5 (3%) received Both at the preceding surgery. The most common organisms involved in monomicrobial infections were Staphylococcus aureus (38, 24%), coagulase-negative staphylococci (36, 23%), and Cutibacterium acnes (6, 4%). Compared with standard care, the other infection prevention techniques were not significantly associated with changes to infecting organisms; AIC was associated with decreased odds of methicillin resistance among coagulase-negative staphylococci. CONCLUSIONS Because no association was found between infection prevention technique and infecting organisms when compared to standard care, other considerations such as tolerability, availability, and cost should inform decisions about infection prevention during CSF shunt placement surgery.

中文翻译：

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标准护理、鞘内抗生素和抗生素浸渍导管与脑脊液分流感染微生物和耐药性的关联。

背景 脑脊液（CSF）分流手术期间使用的感染预防技术包括：（1）标准围手术期静脉注射抗生素，（2）鞘内（IT）抗生素，（3）抗生素浸渍导管（AIC）分流管，或（4）两者IT 和 AIC。尚未对这些技术对感染微生物和抗菌素耐药性模式的影响进行相互评估。方法 我们对 2007 年 1 月至 2012 年 12 月期间在美国 6 家医院首次进行脑脊液分流术的儿童进行了回顾性纵向观察队列研究。数据以电子方式从儿科健康信息系统+ (PHIS+) 数据库中收集，并通过标准化图表审查进行增强。本研究仅纳入脑脊液培养呈阳性的受试者。结果 在研究期间首次进行分流术的 1,723 名儿童中，196 名 (11%) 出现感染，其中 157 名 (80%) 脑脊液培养呈阳性。在这 157 名受试者中，69 名 (44%) 接受了标准护理，28 名 (18%) 接受了 AIC，55 名 (35%) 接受了 IT 抗生素，5 名 (3%) 在之前的手术中接受了两种治疗。涉及单一微生物感染的最常见微生物是金黄色葡萄球菌（38 例，24%）、凝固酶阴性葡萄球菌（36 例，23%）和痤疮皮肤杆菌（6 例，4%）。与标准护理相比，其他感染预防技术与感染微生物的变化没有显着相关性；AIC 与凝固酶阴性葡萄球菌中甲氧西林耐药的几率降低相关。结论 由于与标准护理相比，未发现感染预防技术与感染微生物之间存在关联，因此耐受性、可用性和成本等其他考虑因素应为脑脊液分流术置入手术期间感染预防的决策提供依据。