Linam W Matthew, Margolis Peter A, Staat Mary Allen, Britto Maria T, Hornung Richard, Cassedy Amy, Connelly Beverly L
Divisions of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA.
Infect Control Hosp Epidemiol. 2009 Feb;30(2):109-16. doi: 10.1086/593952.
To identify risk factors associated with surgical site infection (SSI) after pediatric posterior spinal fusion procedure by examining characteristics related to the patient, the surgical procedure, and tissue hypoxia.
Retrospective case-control study nested in a hospital cohort study.
A 475-bed, tertiary care children's hospital.
All patients who underwent a spinal fusion procedure during the period from January 1995 through December 2006 were included. SSI cases were identified by means of prospective surveillance using National Nosocomial Infection Surveillance system definitions. Forty-four case patients who underwent a posterior spinal fusion procedure and developed an SSI were identified and evaluated. Each case patient was matched (on the basis of date of surgery, +/-3 months) to 3 control patients who underwent a posterior spinal fusion procedure but did not develop an SSI. Risk factors for SSI were evaluated by univariate analysis and multivariable conditional logistic regression. Odds ratios (ORs), with 95% confidence intervals (CIs) and P values, were calculated.
From 1995 to 2006, the mean annual rate of SSI after posterior spinal fusion procedure was 4.4% (range, 1.1%-6.7%). Significant risk factors associated with SSI in the univariate analysis included the following: a body mass index (BMI) greater than the 95th percentile (OR, 3.5 [95% CI, 1.5-8.3]); antibiotic prophylaxis with clindamycin, compared with other antibiotics (OR, 3.5 [95% CI, 1.2-10.0]); inappropriately low dose of antibiotic (OR, 2.6 [95% CI, 1.0-6.6]); and a longer duration of hypothermia (ie, a core body temperature of less than 35.5 degrees C) during surgery (OR, 0.4 [95% CI, 0.2-0.9]). An American Society of Anesthesiologists (ASA) score of greater than 2, obesity (ie, a BMI greater than the 95th percentile), antibiotic prophylaxis with clindamycin, and hypothermia were statistically significant in the multivariable model.
An ASA score greater than 2, obesity, and antibiotic prophylaxis with clindamycin were independent risk factors for SSI. Hypothermia during surgery appears to provide protection against SSI in this patient population.
通过检查与患者、手术过程和组织缺氧相关的特征，确定小儿后路脊柱融合术后手术部位感染（SSI）的相关危险因素。
嵌套于医院队列研究中的回顾性病例对照研究。
一家拥有475张床位的三级儿童医院。
纳入1995年1月至2006年12月期间接受脊柱融合手术的所有患者。采用国家医院感染监测系统的定义，通过前瞻性监测确定SSI病例。确定并评估了44例接受后路脊柱融合手术并发生SSI的病例患者。根据手术日期（±3个月），为每例病例患者匹配3例接受后路脊柱融合手术但未发生SSI的对照患者。通过单因素分析和多变量条件逻辑回归评估SSI的危险因素。计算比值比（OR）、95%置信区间（CI）和P值。
1995年至2006年，后路脊柱融合术后SSI的年平均发生率为4.4%（范围为1.1%-6.7%）。单因素分析中与SSI相关的显著危险因素包括：体重指数（BMI）大于第95百分位数（OR，3.5[95%CI，1.5-8.3]）；与其他抗生素相比，使用克林霉素进行抗生素预防（OR，3.5[95%CI，1.2-10.0]）；抗生素剂量过低（OR，2.6[95%CI，1.0-6.6]）；以及手术期间体温过低持续时间较长（即核心体温低于35.5℃）（OR，0.4[95%CI，0.2-0.9]）。在多变量模型中，美国麻醉医师协会（ASA）评分大于2、肥胖（即BMI大于第95百分位数）、使用克林霉素进行抗生素预防和体温过低具有统计学意义。
ASA评分大于2、肥胖和使用克林霉素进行抗生素预防是SSI的独立危险因素。手术期间体温过低似乎对该患者群体的SSI具有保护作用。
