Glotzbecker Michael P, Riedel Matthew D, Vitale Michael G, Matsumoto Hiroko, Roye David P, Erickson Mark, Flynn John M, Saiman Lisa
Department of Orthopaedic Surgery, Harvard Medical School, Children's Hospital Boston, Boston, MA 02115, USA.
J Pediatr Orthop. 2013 Jul-Aug;33(5):479-87. doi: 10.1097/BPO.0b013e318285c507.
Despite relatively high rates of surgical site infections (SSIs) after pediatric spine surgery, practice guidelines are absent. We performed a systematic review of the literature, determining the level of evidence for risk factors for SSIs and prevention practices to reduce SSIs following pediatric spine surgery.
The search utilized the root search words "spine," "scoliosis," and "infection" resulting in 9594 abstracts. Following removal of duplicate abstracts, those that assessed only SSI rates, SSI treatment, nonoperative spine infections, or adult populations, 57 relevant studies were rated for level of evidence and graded using previously validated scales.
Very few studies lead to grade A (good evidence) or grade B (fair evidence) recommendations. Ceramic bone substitute did not increase the risk of SSIs when compared with autograft (grade A). Comorbid medical conditions, particularly cerebral palsy or myelodysplasia; urinary or bowel incontinence; nonadherence to antibiotic prophylaxis protocols; and increased implant prominence increase the risk of SSIs (grade B). SSIs caused by gram-negative bacilli were more frequent in neuromuscular populations and first-generation stainless steel implants increased the risk of delayed infection compared to newer generation titanium implants (grade B). Evaluations of other risk factors for SSIs yielded conflicting or poor-quality evidence (grade C); these included malnutrition or obesity; number of levels fused or fusion extended to the sacrum/pelvis; blood loss; and use of allograft. Insufficient evidence (0 to 1 published studies) was available to recommend numerous practices shown to reduce SSI risk in other populations such as chlorhexidine skin wash the night before surgery, preoperative nasal swabs for Staphylococcus aureus, chlorhexidine skin disinfection, perioperative prophylaxis with intravenous vancomycin, vancomycin, or gentamicin powder in the surgical site or graft.
Few studies have evaluated risk factors and preventive strategies for SSIs following pediatric spine surgery. This systematic review documents the relative lack of evidence supporting SSI prevention practices and highlights priorities for research.
Level III therapeutic study.
尽管小儿脊柱手术后手术部位感染（SSI）发生率相对较高，但目前尚无相关实践指南。我们对文献进行了系统回顾，以确定小儿脊柱手术后SSI危险因素的证据水平以及降低SSI的预防措施。
检索使用了“脊柱”“脊柱侧弯”和“感染”等关键词，共得到9594篇摘要。去除重复摘要后，排除那些仅评估SSI发生率、SSI治疗、非手术性脊柱感染或成人人群的研究，对57项相关研究进行证据水平评级，并使用先前验证的量表进行分级。
极少有研究能得出A级（充分证据）或B级（中等证据）推荐。与自体骨移植相比，陶瓷骨替代物并未增加SSI风险（A级）。合并内科疾病，尤其是脑瘫或脊髓发育不良；尿失禁或大便失禁；不遵守抗生素预防方案；以及植入物突出增加会增加SSI风险（B级）。革兰氏阴性杆菌引起的SSI在神经肌肉疾病人群中更为常见，与新一代钛合金植入物相比，第一代不锈钢植入物增加了延迟感染的风险（B级）。对其他SSI危险因素的评估产生了相互矛盾或质量较差的证据（C级）；这些因素包括营养不良或肥胖；融合节段数量或融合范围延伸至骶骨/骨盆；失血；以及使用同种异体骨。对于其他人群中已证明可降低SSI风险的众多措施，如术前一晚用氯己定清洗皮肤、术前对金黄色葡萄球菌进行鼻腔拭子检查、氯己定皮肤消毒、静脉注射万古霉素进行围手术期预防、在手术部位或移植物中使用万古霉素或庆大霉素粉末等，现有证据不足（0至1篇已发表研究）。
很少有研究评估小儿脊柱手术后SSI的危险因素和预防策略。本系统评价记录了支持SSI预防措施的证据相对不足，并突出了研究重点。
III级治疗性研究。
