Gaviola Marian L, McMillian Wesley D, Ames Suzanne Elizabeth, Endicott Jeffrey A, Alston Wallace Kemper
Department of Pharmacotherapy, University of North Texas System College of Pharmacy, Fort Worth, Texas.
Department of Pharmacy, The University of Vermont Medical Center, Burlington, Vermont.
Pharmacotherapy. 2016 Jan;36(1):19-25. doi: 10.1002/phar.1678. Epub 2016 Jan 9.
Topical vancomycin may be an effective intervention to decrease the risk of postoperative surgical site infections (SSIs). The primary objective of this study was to evaluate the impact of topical vancomycin with intravenous (IV) cefazolin compared with IV cefazolin alone on the incidence of SSI in instrumented multilevel spinal fusion (MLSF) surgery.
This was a retrospective cohort study of patients 18 years and older who underwent instrumented MLSF surgery between January 1, 2010, and July 31, 2014. Patients who underwent anterior cervical diskectomy and fusion, had spine surgery within 3 months prior to index case, received antibiotics other than IV cefazolin prior to surgery, or had preoperative length of stay longer than 5 days were excluded. SSIs were identified using Centers for Disease Control and Prevention National Healthcare Safety Network definitions. Summary statistics were computed. Variables found to be associated with increased risk of SSI through univariate analysis were included in a multivariate analysis.
Among 326 patients, 29 (8.9%) developed an SSI. Univariate analysis showed a trend toward decreased SSI incidence in the cohort receiving topical vancomycin with IV cefazolin compared with IV cefazolin alone, although this was not statistically significant ([6/116] 5.2% vs [23/210] 11.0%, p = 0.08). Topical vancomycin was associated with a protective effect against SSI in the multivariate analysis (odds ratio [OR] 0.26, p = 0.02). Significant risk factors for the development of SSI included female sex (OR 3.3, p = 0.01), increasing invasiveness score (p < 0.01), and diabetes mellitus (OR 5.1, p < 0.01).
Topical vancomycin administered in addition to IV cefazolin was associated with a decreased risk of SSI in high-risk MLSF patients. Female patients and those with diabetes mellitus were at higher risk of developing postsurgical infection. Further prospective studies are needed to confirm these results and to define the most clinically effective dose of topical vancomycin in this patient population.
局部应用万古霉素可能是一种降低术后手术部位感染（SSI）风险的有效干预措施。本研究的主要目的是评估局部应用万古霉素联合静脉注射（IV）头孢唑林与单纯静脉注射头孢唑林相比，对多节段器械辅助脊柱融合（MLSF）手术中SSI发生率的影响。
这是一项回顾性队列研究，研究对象为2010年1月1日至2014年7月31日期间接受器械辅助MLSF手术的18岁及以上患者。排除接受过颈椎前路椎间盘切除术和融合术、在索引病例前3个月内进行过脊柱手术、术前接受过除静脉注射头孢唑林以外的抗生素治疗或术前住院时间超过5天的患者。使用疾病控制与预防中心国家医疗安全网络的定义来确定SSI。计算汇总统计数据。通过单因素分析发现与SSI风险增加相关的变量纳入多因素分析。
326例患者中，29例（8.9%）发生了SSI。单因素分析显示，与单纯静脉注射头孢唑林相比，接受局部应用万古霉素联合静脉注射头孢唑林的队列中SSI发生率有降低趋势，尽管差异无统计学意义（[6/116]5.2%对[23/210]11.0%，p = 0.08）。多因素分析中，局部应用万古霉素对SSI有保护作用（比值比[OR]0.26，p = 0.02）。发生SSI的显著风险因素包括女性（OR 3.3，p = 0.01）、侵袭性评分增加（p < 0.01）和糖尿病（OR 5.1，p < 0.01）。
在高危MLSF患者中，静脉注射头孢唑林的基础上加用局部应用万古霉素与SSI风险降低相关。女性患者和糖尿病患者术后发生感染的风险较高。需要进一步的前瞻性研究来证实这些结果，并确定该患者群体中局部应用万古霉素的最临床有效剂量。
