Patel Harshila, Khoury Hanane, Girgenti Douglas, Welner Sharon, Yu Holly
1 LASER Analytica , Montreal, Canada .
2 Pfizer Inc. , Pearl River, New York.
Surg Infect (Larchmt). 2017 May/Jun;18(4):461-473. doi: 10.1089/sur.2016.186. Epub 2016 Nov 30.
Spine operations may be indicated for treatment of diseases including vertebral injuries, degenerative spinal conditions, disk disease, spinal misalignments, or malformations. Surgical site infection (SSI) is a clinically important complication of spine surgery. Staphylococcus aureus, including methicillin-resistant Staphylococcus aureus (MRSA), is a leading cause of post-spinal SSIs.
PubMed and applicable infectious disease conference proceedings were searched to identify relevant published studies. Overall, 343 full-text publications were screened for epidemiologic, mortality, health care resource utilization, and cost data on SSIs associated with specified spine operations.
Surgical site infection rates were identified in 161 studies from North America, Europe, and Asia. Pooled average SSI and S. aureus SSI rates for spine surgery were 1.9% (median, 3.3%; range, 0.1%-22.6%) and 1.0% (median, 2.0%; range, 0.02%-10.0%). Pooled average contribution of S. aureus infections to spinal SSIs was 49.3% (median, 50.0%; range, 16.7%-100%). Pooled average proportion of S. aureus SSIs attributable to MRSA was 37.9% (median, 42.5%; range, 0%-100%). Instrumented spinal fusion had the highest pooled average SSI rate (3.8%), followed by spinal decompression (1.8%) and spinal fusion (1.6%). The SSI-related mortality rate among spine surgical patients ranged from 1.1%-2.3% (three studies). All studies comparing SSI and control cohorts reported longer hospital stays for patients with SSIs. Pooled average SSI-associated re-admission rate occurring within 30 d from discharge ranged from 20% to 100% (four studies). Pooled average SSI-related re-operation rate was 67.1% (median, 100%; range, 33.5%-100%). According to two studies reporting direct costs, spine surgical patients incur approximately double the health care costs when they develop an SSI.
Available published studies demonstrate a clinically important burden of SSIs related to spine operations and the substantial contribution of S. aureus (including MRSA). Preventive strategies aimed specifically at S. aureus SSIs could reduce health care costs and improve patient outcomes for spine operations.
脊柱手术可用于治疗包括椎体损伤、脊柱退行性疾病、椎间盘疾病、脊柱排列不齐或畸形等疾病。手术部位感染（SSI）是脊柱手术临床上重要的并发症。金黄色葡萄球菌，包括耐甲氧西林金黄色葡萄球菌（MRSA），是脊柱手术后SSI的主要原因。
检索PubMed及相关传染病会议论文集以确定相关已发表研究。总体而言，对343篇全文出版物进行了筛查，以获取与特定脊柱手术相关的SSI的流行病学、死亡率、医疗资源利用和成本数据。
在来自北美、欧洲和亚洲的161项研究中确定了手术部位感染率。脊柱手术的合并平均SSI率和金黄色葡萄球菌SSI率分别为1.9%（中位数为3.3%；范围为0.1%-22.6%）和1.0%（中位数为2.0%；范围为0.02%-10.0%）。金黄色葡萄球菌感染对脊柱SSI的合并平均贡献率为49.3%（中位数为50.0%；范围为16.7%-100%）。金黄色葡萄球菌SSI中归因于MRSA的合并平均比例为37.9%（中位数为42.5%；范围为0%-100%）。器械辅助脊柱融合术的合并平均SSI率最高（3.8%），其次是脊柱减压术（1.8%）和脊柱融合术（1.6%）。脊柱手术患者中与SSI相关的死亡率在1.1%-2.3%之间（三项研究）。所有比较SSI组和对照组的研究均报告SSI患者的住院时间更长。出院后30天内发生的合并平均SSI相关再入院率在20%至100%之间（四项研究）。合并平均SSI相关再次手术率为67.1%（中位数为100%；范围为33.5%-100%）。根据两项报告直接成本的研究，脊柱手术患者发生SSI时的医疗费用约增加一倍。
现有已发表研究表明，与脊柱手术相关的SSI在临床上具有重要负担，且金黄色葡萄球菌（包括MRSA）起了很大作用。专门针对金黄色葡萄球菌SSI的预防策略可降低医疗成本并改善脊柱手术患者的预后。
