Introduction

Ventriculoperitoneal shunts (VPS) is commonly performed by pediatric neurosurgeons and there is no consensus in management of VPS infection as it relates to diagnosis and treatment.

Objective

We utilized an international practitioner-based survey to study the variability in VPS infection diagnostic and therapeutic measures.

Methods

A survey gauging practice patterns of pediatric neurosurgeons regarding VPS and its complication management was distributed. Survey endpoints were analyzed by VPS case volume and pediatric-focused case volume regarding diagnostic measures, use of cerebrospinal fluid (CSF) profile, microbiology, and treatment.

Results

A total of 439 surveys were distributed, with a response rate of 31%. Responders ranged from Americas (44.9%), European (31.4%), Asian (18.6%), African (2.5%), to Australian continents (2.5%). Practitioners were stratified based on number and percentage pediatric VPS performed. Institutions performing highest VPS and percentage pediatric case volumes had lower rate of VPS infection. Shunt tap was the most widely used diagnostic study. Overall CSF profile did not affect decision making towards VPS internalization, except for leukocyte count ≤ 20 × 10⁹/L. Practitioners utilized 3 negative cultures prior to VPS internalization. Discrepancies in surgical management were noted amongst centers with high versus low VPS volume and proportion of pediatric-focused case volume. Practice patterns were not noted to be organism dependent. Antibiotic-impregnated shunts were utilized in the Americas and Europe over other regions but only in one third of all initial VPS or as a preventive strategy after a VPS infection has been resolved respectively.

Discussion

Survey results from 6 continents in VPS management revealed patterns of lower infection in high-volume centers, 3 negative cultures prior to internalization and aggressive surgical VPS infection management in high-volume institutions.

中文翻译：

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脑脊液分流感染评估和管理的全球趋势：一项ISPN合作调查。

介绍

腹膜腹腔分流术（VPS）通常由儿科神经外科医生进行，在VPS感染的管理与诊断和治疗有关方面尚无共识。

目的

我们利用一项基于国际从业人员的调查来研究VPS感染诊断和治疗措施的变异性。

方法

分发了关于VPS及其并发症管理的小儿神经外科医师的测量实务模式调查。通过VPS病例量和以儿科为中心的病例量来分析调查终点，涉及诊断措施，脑脊液（CSF）使用情况，微生物学和治疗。

结果

总共分发了439个调查，答复率为31％。回答者从美洲（44.9％），欧洲（31.4％），亚洲（18.6％），非洲（2.5％）到澳大利亚各大洲（2.5％）不等。根据执行的儿科VPS的数量和百分比对从业者进行分层。VPS最高和儿科病例数量百分比最高的机构的VPS感染率较低。分流水龙头是使用最广泛的诊断研究。除了白细胞计数≤20×10 ⁹之外，总体CSF分布图不影响VPS内部化的决策/升 从业人员在VPS内化之前使用了3种阴性培养物。在高VPS量和低VPS量以及以儿科为中心的病例量比例中，各中心之间的手术管理存在差异。没有指出实践模式是有机体依赖性的。美洲和欧洲在其他地区使用了浸有抗生素的分流器，但仅在所有初始VPS中使用了三分之一，或者在解决VPS感染后分别用作预防策略。

讨论区

来自六大洲VPS管理的调查结果显示，在大容量医疗机构中感染率较低，在内部化之前出现3种阴性培养，而在大容量机构中进行积极的VPS感染管理。