Topical vancomycin reduces the cerebrospinal fluid shunt infection rate: a retrospective cohort study

Object: Despite many efforts at reduction, cerebrospinal fluid (CSF) shunt infections are a major cause of morbidity in shunt surgery, occurring in 5-15% of cases. To attempt to reduce the shunt infection rate at our institution, we added topical vancomycin (intrashunt and perishunt) to our existing shunt infection prevention protocol in 2012. Methods: We performed a retrospective cohort study comparing all shunted patients in January 2010 to December 2011 without vancomycin (control group, 263 procedures) to all patients who underwent shunt surgery between April 2012 and December 2015 with vancomycin (intervention group, 499 procedures). Results: The overall shunt infection rate significantly decreased from 6.8% (control group) to 3.0% (intervention group) (p = 0.023, absolute risk reduction 3.8%, relative risk reduction 56%). Multivariate logistic regression analysis confirmed that the addition of topical vancomycin showed that cases treated under a protocol of topical vancomycin wer...研究背景与目标：尽管已采取多种措施试图降低感染发生率，脑脊液（cerebrospinal fluid, CSF）分流术感染仍是分流手术患者发病的主要诱因，其发生率可达5%~15%。为降低本机构内的分流术感染率，我们于2012年在现有分流手术感染预防方案中加入了局部用万古霉素（分流管内及术周给药）。研究方法：本研究为回顾性队列研究，将2010年1月至2011年12月期间未使用万古霉素的所有分流手术患者设为对照组（共263例次手术），与2012年4月至2015年12月期间接受分流手术且使用万古霉素的干预组患者（共499例次手术）进行对比分析。研究结果：总体分流术感染率从对照组的6.8%显著降至干预组的3.0%（p=0.023，绝对风险降低3.8%，相对风险降低56%）。多因素logistic回归分析证实，加用局部用万古霉素的干预方案中，接受局部万古霉素治疗的病例...