BACKGROUND Ventriculoperitoneal shunt placement remains the primary treatment modality for children with hydrocephalus. However, morbidity and revision surgery secondary to infection remains high, even while using antibiotic-impregnated shunts. OBJECTIVE To determine whether intraoperative injection of antibiotics is independently associated with reduced rates of infection and revision surgery in children undergoing shunt placement. METHODS This is an analysis of a prospectively collected, multicenter, shunt-specific neurosurgical registry consisting of data from over 100 hospitals collected between 2016 and 2017. All patients under 18 yr of age undergoing first-time shunt placement for the definitive treatment of hydrocephalus were included. The primary exposure of interest was injection of intraventricular antibiotics into the shunt catheter following shunt placement and prior to closure. The use of additional surgical adjuncts, such as antibiotic-impregnated shunts, stereotactic guidance, and endoscopy was collected. The primary outcome metric was the need for additional intervention because of an infection. RESULTS A total of 2007 pediatric patients undergoing shunt placement for hydrocephalus were identified. Postoperatively, 97 (4.8%) patients had additional intervention secondary to infection. In a multivariable regression model controlling for patient characteristics, etiology of hydrocephalus, prior temporizing measures, and placement of an antibiotic-impregnated shunt, injection of intraventricular antibiotics was associated with a significant reduction in postoperative infections (odds ratio = 0.29, 95% CI: 0.04-0.89, P = .038). Of those receiving intraventricular antibiotics, only 2 (0.38%) went on to undergo re-intervention due to infection. CONCLUSION These data suggest that for this select group of patients, use of intraventricular antibiotics was associated with decreased rates of re-intervention secondary to infection.

中文翻译：

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预防性脑室内抗生素在降低分流术小儿患者感染和修复手术发生率中的作用

背景脑室腹腔分流术仍然是儿童脑积水的主要治疗方式。然而，继发于感染的发病率和翻修手术仍然很高，即使使用抗生素浸渍的分流器也是如此。目的 确定术中注射抗生素是否与接受分流术的儿童感染率和翻修手术率降低独立相关。方法 这是对前瞻性收集的、多中心的、分流特异性神经外科登记的分析，该登记包括来自 2016 年至 2017 年期间收集的 100 多家医院的数据。所有 18 岁以下接受首次分流术以根治脑积水的患者均为包括。感兴趣的主要暴露是在分流放置后和闭合前将脑室内抗生素注射到分流导管中。收集了其他手术辅助工具的使用情况，例如抗生素浸渍分流器、立体定向引导和内窥镜检查。主要结果指标是由于感染而需要额外干预。结果 共确定了 2007 名因脑积水而接受分流术的儿科患者。术后，97 名 (4.8%) 患者接受了继发于感染的额外干预。在控制患者特征、脑积水病因、先前临时措施和抗生素浸渍分流器位置的多变量回归模型中，脑室内注射抗生素与术后感染显着减少有关（优势比 = 0.29，95% CI：0.04-0.89，P = .038）。在接受脑室内抗生素治疗的患者中，只有 2 人（0.38%）因感染继续接受再干预。结论 这些数据表明，对于这组选定的患者，使用脑室内抗生素与继发于感染的再干预率降低有关。