Associations of Standard Care, Intrathecal Antibiotics, and Antibiotic-Impregnated Catheters With Cerebrospinal Fluid Shunt Infection Organisms and Resistance.

Autor: Sedano S; Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA., Kronman MP; Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA.; Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington, USA., Whitlock KB; New Harmony Statistical Consulting LLC, Clinton, Washington, USA., Zhou C; Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA.; Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington, USA., Coffin SE; Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA., Hauptman JS; Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA.; Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA., Heller E; Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA., Mangano FT; Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA., Pollack IF; Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA., Schaffzin JK; Department of Pediatrics, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada., Thorell E; Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA., Warf BC; Department of Neurosurgery, Harvard School of Medicine, Boston, Massachusetts, USA., Simon TD; Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA.; Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, California, USA.; The Saban Research Institute, Los Angeles, California, USA.
Jazyk: angličtina
Zdroj: Journal of the Pediatric Infectious Diseases Society [J Pediatric Infect Dis Soc] 2023 Sep 27; Vol. 12 (9), pp. 504-512.
DOI: 10.1093/jpids/piad064
Abstrakt: 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.
(© The Author(s) 2023. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze: MEDLINE
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