Wave Shen: Ask @Prof. Li Xiaoyong: Hi Prof. Li, is it necessary to use vancomycin as early as possible to prevent the high mortality rate after infection in patients undergoing secondary surgery? Prof. Li Xiaoyong: The phenomenon of high mortality rate after infection in patients undergoing secondary surgery you mentioned should be in the past, the mortality rate was approximately 90% before 1995. But after 95 years, our cure rate has gradually improved, and now our cure rate in cerebrospinal fluid department is above 90%, reversing the previous historical results. However, we have identified some problems, such as various medical delays in the diagnosis and accurate treatment of shunt infections, which have resulted in a number of severely disabling and fatal cases that could have been cured if they had been treated early and correctly. Early or early treatment will certainly reduce the morbidity and mortality rate of shunt infection greatly, but do not think that shunt infection is only early use of vancomycin, this method may be a phenomenon that the neurosurgeons of Tiantan Hospital spread the results of my initial research around, which was my discovery before I went abroad 2000 years ago. Now that our new technology, which is not so fully popularized because I am not currently at Tiantan Hospital, is no longer comprehensive by proposing the vancomycin-only approach, imagine: how would one antibiotic treat a wide variety of bacterial-caused shunt infections? Of course this is still a better and meaningful approach. Also still to remind with you: the idea of using vancomycin early after shunt surgery to prevent shunt infection after secondary surgery has been proven to be a very bad approach, because this approach generally does not prevent shunt infection in the postoperative period. 凌雪愁 ：向@李小勇教授 提问：Hello Professor Li, under what circumstances is intrathecal administration necessary? Thank you! Prof. Li Xiaoyong: I don’t know what kind of drugs you are referring to when you say intrathecal administration? Nowadays, there is a drug called stem cell transplantation, which is also given intrathecally, but it has caused many intracranial infections instead of treating infections, which should be taken seriously by colleagues. I guess the drug you are referring to may be an antibiotic, which can be considered intrathecally when intracranial infection is combined with intracranial hypertension or hydrocephalus, or in certain cases where intravenous is ineffective, there are no strict rules. Daidai Zhang ：Question for @Prof. Xiaoyong Li：Hello Prof. Li, what are the preferred drugs for anti-infective treatment of post-cerebrospinal fluid shunt infection? Prof. Li Xiaoyong: Infection after bypass is a major concern. The question of the preferred drug for anti-infection treatment depends on the nature of the cerebrospinal fluid disease in your unit. In general hospitals, what I call low-level hospitals with cerebrospinal fluid disease, drugs should be used based on empirical treatment of the spectrum of bacterial species that infect hospitals in general. I did a study on this between 1995-2005 and found that coccus accounted for 80% and bacillus for 20%, and vancomycin was preferred, and it may still be applicable to primary hospitals treating cerebrospinal fluid disease. I also think there is some clinical experience knowledge that is difficult to fully express here. But no matter what, please don’t base your treatment plan on the so-called preferred drug from the beginning to the end, but correct or adjust it according to the results of bacterial culture in time is the essence of anti-infection.