Vandenberg Curt, Niswander Cameron, Carry Patrick, Bloch Nikki, Pan Zhaoxing, Erickson Mark, Garg Sumeet
Orthopaedics Institute.
Musculoskeletal Research Center, Children's Hospital Colorado, Aurora, CO.
J Pediatr Orthop. 2018 May/Jun;38(5):287-292. doi: 10.1097/BPO.0000000000000812.
A multidisciplinary task force, designated Target Zero, has developed protocols for prevention of surgical site infection (SSI) for spine surgery at our institution. The purpose of this study was to evaluate how compliance with an antibiotic bundle impacts infection incidences in pediatric spine surgery.
After institutional review board approval, a consecutive series of 511 patients (517 procedures) who underwent primary spine procedures from 2008 to 2012 were retrospectively reviewed to identify patients who developed SSI. Patients were followed for a minimum of 90 days postoperatively. Compliance data were collected prospectively in 511 consecutive patients and a total of 517 procedures. Three criteria were required for antibiotic bundle compliance: appropriate antibiotics completely administered within 1 hour before incision, antibiotics appropriately redosed intraoperatively for blood loss and time, and antibiotics discontinued within 24 hours postoperatively. A multivariable logistic regression analysis was used to test the association between compliance and the development of an infection.
Overall antibiotic bundle compliance rate was 85%. After adjusting for risk category, estimated blood loss, and study year, the likelihood of an infection was increased in the noncompliant group compared with the compliant group (adjusted odds ratio: 3.0, 95% CI, 0.96-9.47, P=0.0587). When expressed as the number needed to treat, strict adherence to antibiotic bundle compliance prevented 1 SSI within 90 days of surgery for every 26 patients treated with the antibiotic bundle. Reasons for noncompliance included failure to infuse preoperative antibiotics 1 hour before incision (10.3%), failure to redose antibiotics intraoperatively based on time or blood loss (5.5%), and failure to discontinue antibiotics within 24 hours postoperatively (1.9%).
Compliance with a comprehensive antibiotic protocol can lead to meaningful reductions in SSI incidences in pediatric spine surgery. Institutions should focus on improving compliance with prophylactic antibiotic protocols to decrease SSI in pediatric spine surgery.
Level III-retrospective cohort study.
一个名为“零目标”的多学科特别工作组已经制定了我们机构脊柱手术部位感染（SSI）的预防方案。本研究的目的是评估抗生素集束方案的依从性如何影响小儿脊柱手术的感染发生率。
经机构审查委员会批准，对2008年至2012年接受初次脊柱手术的511例患者（517例手术）进行连续回顾性研究，以确定发生SSI的患者。术后对患者进行至少90天的随访。前瞻性收集511例连续患者和总共517例手术的依从性数据。抗生素集束方案依从性需要满足三个标准：在切开前1小时内完全给予适当的抗生素，术中根据失血情况和时间适当重新给药抗生素，以及术后24小时内停用抗生素。采用多变量逻辑回归分析来检验依从性与感染发生之间的关联。
总体抗生素集束方案依从率为85%。在对风险类别、估计失血量和研究年份进行调整后，与依从组相比，不依从组发生感染的可能性增加（调整后的优势比：3.0，95%可信区间，0.96 - 9.47，P = 0.0587）。以需治疗人数表示，严格遵守抗生素集束方案依从性可使每26例接受抗生素集束方案治疗的患者在术后90天内预防1例SSI。不依从的原因包括切开前1小时内未输注术前抗生素（10.3%）、术中未根据时间或失血情况重新给药抗生素（5.5%）以及术后24小时内未停用抗生素（1.9%）。
遵守全面的抗生素方案可使小儿脊柱手术的SSI发生率显著降低。机构应专注于提高预防性抗生素方案的依从性，以降低小儿脊柱手术中的SSI。
III级 - 回顾性队列研究。
