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Ependimitis asociada a sistema de derivación ventrículo peritoneal en el Hospital de Pediatría del Centro Médico Nacional Siglo XXI, IMSS
Abstract
Resumen Objetivo. Describir el comportamiento de las ependimitis en el Hospital de Pediatría del Centro Médico Nacional Siglo XXI en el 2005. Material y métodos. Serie de casos. Se revisaron los expedientes de pacientes con diagnóstico de ependimitis durante un año, definiéndose como ependimitis aquellos pacientes con antecedente de derivación ventrículo peri- toneal (DVP), cuadro sugestivo y aislamiento de microorganismo en cultivo de líquido cefalorraquídeo. Resultados. Se revisaron 30 casos de ependimitis en 22 pacientes: quince con un episodio, seis con dos episo- dios y uno con tres episodios. Los lactantes fueron el grupo más afectado, la principal causa de hidrocefalia fue hemorragia intraventricular, el tiempo de presentación en relación con la colocación de DVP fue al primer mes, la principal manifestación clínica fue disfunción valvular, dentro de los agentes implicados se encontraron Staphylo- coccus coagulasa negativa, Enterococos spp y enterobacterias. En cuanto al tratamiento el porcentaje de éxito fue de 60%, la terapia sistémica logró curación en 67% de los casos y la terapia local en 50%. Conclusiones. La presentación y los agentes etiológicos son similares a lo reportado en la literatura mundial. Respecto al tratamiento en este estudio la eficacia de la terapia sistémica fue de 67%, existiendo un cambio epide- miológico respecto a años anteriores, lo cual llevará a plantear opciones terapéuticas diferentes. Palabras clave: ependimitis, hidrocefalia, terapia sistémica, terapia local.
... Median age of the group with bacterial growth was 5 months, whereas in the goup without, it was 1 year, with a p-value of 0.25. The age group where the highest risk for having infectious complications was observed was the infants; these data are shown in table 1. Arnold Chiari II, n (%) 20 (20) 142 (22) CNS infections, n (%) 9 (9) 10 (2) Posterior fossa tumor, n (%) 5 (5) 64 ( The main hydrocephalus etiology in patients with bacterial growth was aqueductal stenosis, whereas in the control group, it was intraventricular hemorrhage; however, differences were not significant between both groups, as shown in table 2. ...
Objective:
To determine risk factors associated with bacterial growth in systems derived from cerebrospinal fluid in pediatric patients.
Methods:
Case and controls study from January to December 2012, in patients aged < 16 years who were carriers of hydrocephalus and who required placement or replacement of derivative system. Cases were considered as children with cultures with bacterial growth and controls with negative bacterial growth. Inferential statistics with Chi-squared and Mann-Whitney U tests. Association of risk with odds ratio.
Results:
We reviewed 746 registries, cases n = 99 (13%) and controls n = 647 (87%). Masculine gender 58 (57%) vs. feminine gender 297 (46%) (p = 0.530). Age of cases: median, five months and controls, one year (p = 0.02). Median weight, 7 vs. 10 kg (p = 0.634). Surgical interventions: median n = 2 (range, 1-8) vs. n = 1 (range, 1-7). Infection rate, 13.2%. Main etiology ductal stenosis, n = 29 (29%) vs. n = 50 (23%) (p = 0.530). Non-communicating, n = 50 (51%) vs. 396 (61%) (p = 0.456). Predominant microorganisms: enterobacteria, pseudomonas, and enterococcus. Non-use of iodized dressing OR = 2.6 (range, 1.8-4.3), use of connector OR = 6.8 (range, 1.9-24.0), System replacement OR = 2.0 (range, 1.3-3.1), assistant without surgical facemask OR = 9.7 (range, 2.3-42.0).
Conclusions:
Being a breastfeeding infant, of low weight, non-application of iodized dressing, use of connector, previous derivation, and lack of adherence to aseptic technique were all factors associated with ependymitis.
Shunt infection remains the foremost problem of shunt implantation after mechanical malfunctions. Diversionary cerebrospinal fluid shunt implantation has a high complication rate, with 5% to 15% of such shunts becoming infected. Of these infections, 70% are diagnosed within 1 month after surgery and more than 90% within 6 months. Shunt infection in the vast majority of cases is therefore a complication of shunt surgery. The authors review their experience with shunt implantation during two time periods. From January, 1978, to December, 1982, 302 children with hydrocephalus underwent 606 operations. Among these children, 47 (15.56%) developed a proven shunt infection, with an incidence of infection per procedure of 7.75%. As a result of this study, a new protocol for shunt procedures involving modifications in the immediate pre-, intra-, and postoperative management of children undergoing shunt implantation was initiated. With this new protocol, 600 children underwent a total of 1197 procedures between January, 1983, and December, 1990. The incidence of shunt infection decreased dramatically, with two infections (0.33%) in 600 patients and a per-procedure rate of 0.17%. The overall annual risk of a shunt infection in the pediatric neurosurgical unit is currently 1.04%.
Derivación ventricular y ependimitis (Parte I y II)
- C Díaz-Padilla
- López
- Ga Vázquez
- Diegoperez
- J Ramírez
- Palacios
- Gc Saucedo
- Hidrocefalia
Díaz-Padilla C, López-Vázquez GA, Diegoperez-Ramírez J, Palacios-Saucedo GC. Hidrocefalia, Derivación ventricular y ependimitis (Parte I y II). Enf Infec Microb 2003; 23: 39-49