Ghobrial George M, Thakkar Vismay, Singhal Saurabh, Oppenlander Mark E, Maulucci Christopher M, Harrop James S, Jallo Jack, Prasad Srinivas, Saulino Michael, Sharan Ashwini D
Department of Neurological Surgery, Thomas Jefferson University Hospital, 909 Walnut Street, 3rd floor, Philadelphia, PA 19107, USA.
Department of Neurological Surgery, Thomas Jefferson University Hospital, 909 Walnut Street, 3rd floor, Philadelphia, PA 19107, USA; Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, AZ, USA.
J Clin Neurosci. 2014 Oct;21(10):1786-9. doi: 10.1016/j.jocn.2014.04.007. Epub 2014 Jun 14.
We aimed to assess the efficacy of intraoperative vancomycin powder in intrathecal baclofen pump placement patients, a high risk population. A retrospective review was conducted using prospectively collected data at an academic tertiary care unit. The neurosurgical adult patient population was queried for all intrathecal baclofen pump implantation procedures. Patients were then reviewed for the use of intraoperative crystalline vancomycin powder. Those with a history of prior surgical site infection, chronic systemic infections or osteomyelitis were excluded. Anhydrous, crystalline vancomycin was utilized in the wound bed after completion of implantation, distributed evenly in the case of multiple incisions. Patients received 500 mg or 1,000 mg of crystallized vancomycin, evenly distributed through the wound layers based on a 70 kg weight cutoff. Intraoperative institutional standards of infection prophylaxis were unchanged throughout the study period. Infection rate of baclofen pump placement prior to the use of vancomycin powder from 2001-2009 at the same institution was monitored. Wound infection rate was tracked for a 12 month postoperative period. Six patients out of 26 baclofen pump implantations (23%) in this cohort were identified to have seven infections despite vancomycin powder placement in the lumbar and catheter wounds. Prior infection rates have been investigated for intrathecal drug delivery systems from 2001 to 2009 at the same institution with an overall infection rate of 3% (8/274). The use of vancomycin powder in patients with implants in this series did not reduce infection rates compared to published historical controls, and was elevated compared to institutional controls. Further prospective study of this high risk patient population is warranted.
我们旨在评估术中使用万古霉素粉末对鞘内注射巴氯芬泵植入患者（高危人群）的疗效。在一家学术性三级护理机构，我们使用前瞻性收集的数据进行了一项回顾性研究。查询了神经外科成年患者群体中所有鞘内注射巴氯芬泵植入手术的情况。然后对患者使用术中结晶万古霉素粉末的情况进行评估。排除有既往手术部位感染、慢性全身感染或骨髓炎病史的患者。植入完成后，在伤口床使用无水结晶万古霉素，若有多个切口则均匀分布。根据70kg体重界限，患者接受500mg或1000mg结晶万古霉素，均匀分布于伤口各层。在整个研究期间，术中预防感染的机构标准保持不变。监测了同一机构2001年至2009年在使用万古霉素粉末之前鞘内注射巴氯芬泵植入的感染率。术后12个月追踪伤口感染率。在该队列中，26例鞘内注射巴氯芬泵植入手术中有6例（23%）被确定发生了7次感染，尽管在腰部和导管伤口放置了万古霉素粉末。同一机构在2001年至2009年对鞘内给药系统的既往感染率进行了调查，总体感染率为3%（8/274）。与已发表的历史对照相比，本系列植入患者中使用万古霉素粉末并未降低感染率，且与机构对照相比有所升高。对这一高危患者群体进行进一步的前瞻性研究是有必要的。
