Scanlon Maura M, Gazelka Halena M, Moeschler Susan M, Hoelzer Bryan C, Hooten W M, Bendel Markus A, Lamer Tim J
Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA.
Pain Med. 2017 Mar 1;18(3):520-525. doi: 10.1093/pm/pnw203.
Our purpose was to determine the incidence of surgical site infection (SSI) in cancer patients receiving an intrathecal drug delivery system (IDDS) and compare that rate with the incidence of SSI in the general population receiving an IDDS or spinal cord stimulator. We attempted to describe risk factors for SSIs in cancer patients treated with IDDS in terms of exposure to cancer treatments.
Retrospective review.
Large tertiary care center.
Cancer patients receiving an IDDS in 2006-2013.
The incidence of SSI was determined according to the US Centers for Disease Control and Prevention definition. Medication regimens and current cancer treatment were investigated to identify immunocompromised patients during IDDS placement. Microbacteriology, treatment, and overall outcomes were investigated.
Sixty-four patients had an IDDS implanted in 2006-2013. SSI developed in four patients (6.2%). All four patients had received chemotherapy or radiotherapy within three months before implantation. Three of the three were receiving dexamethasone, and three of the four required explantation of the IDDS.
The incidence of SSI was at the upper end of the published infection rates for IDDS. The risk of SSI may be increased in this population because of factors that alter the patient's immune status, including concomitant corticosteroid use, radiotherapy near the SSI, and presence of immunomodulators. The identification and mitigation of certain risk factors for this population may prevent infection in future patients.
我们的目的是确定接受鞘内药物输注系统（IDDS）的癌症患者手术部位感染（SSI）的发生率，并将该发生率与接受IDDS或脊髓刺激器的普通人群的SSI发生率进行比较。我们试图根据癌症治疗暴露情况来描述接受IDDS治疗的癌症患者发生SSI的危险因素。
回顾性研究。
大型三级医疗中心。
2006年至2013年接受IDDS的癌症患者。
根据美国疾病控制与预防中心的定义确定SSI的发生率。调查用药方案和当前癌症治疗情况，以确定IDDS植入期间的免疫功能低下患者。对微生物学、治疗及总体结局进行调查。
2006年至2013年有64例患者植入了IDDS。4例患者发生了SSI（6.2%）。所有4例患者在植入前三个月内均接受了化疗或放疗。其中3例正在接受地塞米松治疗，4例中有3例需要取出IDDS。
SSI的发生率处于已发表的IDDS感染率范围的上限。由于改变患者免疫状态的因素，包括同时使用皮质类固醇、SSI附近的放疗以及免疫调节剂的存在，该人群发生SSI的风险可能会增加。识别并减轻该人群的某些危险因素可能会预防未来患者发生感染。
