术中局部应用万古霉素粉末是脊柱手术手术部位感染的解决办法吗？
Is Intraoperative Local Vancomycin Powder the Answer to Surgical Site Infections in Spine Surgery?
作者信息
Hey Hwee Weng Dennis, Thiam Desmond Wei, Koh Zhi Seng Darren, Thambiah Joseph Shantakumar, Kumar Naresh, Lau Leok-Lim, Liu Ka-Po Gabriel, Wong Hee-Kit
机构信息
Department of Orthopaedic Surgery, National University Hospital, Singapore, Singapore.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
出版信息
Spine (Phila Pa 1976). 2017 Feb 15;42(4):267-274. doi: 10.1097/BRS.0000000000001710.
STUDY DESIGN
This is a retrospective cohort comparative study of all patients who underwent instrumented spine surgery at a single institution.
OBJECTIVE
To compare the rate of surgical site infection (SSI) between the treatment (vancomycin) and the control group (no vancomycin) in patients undergoing instrumented spine surgery.
SUMMARY OF BACKGROUND DATA
SSI after spine surgery is a dreaded complication associated with increased morbidity and mortality. Prophylactic intraoperative local vancomycin powder to the wound has been recently adopted as a strategy to reduce SSI but results have been variable.
METHODS
In the present study, there were 117 (30%) patients in the treatment group and 272 (70%) patients in the comparison cohort. All patients received identical standard operative and postoperative care procedures based on protocolized department guidelines. The present study compared the rate of SSI with and without the use of prophylactic intraoperative local vancomycin powder in patients undergoing various instrumented spine surgery, adjusted for confounders.
RESULTS
The overall rate of SSI was 4.7% with a decrease in infection rate found in the treatment group (0.9% vs. 6.3%). This was statistically significant (P = 0.049) with an odds ratio of 0.13 (95% confidence interval 0.02-0.99). The treatment group had a significantly shorter onset of infection (5 vs. 16.7 days; P < 0.001) and shorter duration of infection (8.5 vs. 26.8 days; P < 0.001). The most common causative organism was Pseudomonas aeruginosa (35.2%). Patient diagnosis, surgical approach, and intraoperative blood loss were significant risk factors for SSI after multivariable analysis.
CONCLUSION
Prophylactic Intraoperative local vancomycin powder reduces the risk and morbidity of SSI in patients undergoing instrumented spine surgery. P. aeruginosa infection is common in the treatment arm. Future prospective randomized controlled trials in larger populations involving other spine surgeries with a long-term follow-up duration are recommended.
LEVEL OF EVIDENCE
研究设计
这是一项对在单一机构接受脊柱器械手术的所有患者进行的回顾性队列比较研究。
目的
比较接受脊柱器械手术的患者中治疗组（万古霉素）和对照组（未使用万古霉素）的手术部位感染（SSI）发生率。
背景数据总结
脊柱手术后的SSI是一种可怕的并发症，与发病率和死亡率增加相关。术中预防性局部应用万古霉素粉末作为降低SSI的一种策略最近已被采用，但结果不一。
方法
在本研究中，治疗组有117例（30%）患者，对照组有272例（70%）患者。所有患者均根据标准化科室指南接受相同的标准手术和术后护理程序。本研究比较了在接受各种脊柱器械手术的患者中使用和不使用术中预防性局部万古霉素粉末的SSI发生率，并对混杂因素进行了调整。
结果
SSI的总体发生率为4.7%，治疗组的感染率有所下降（0.9%对6.3%）。这具有统计学意义（P = 0.049），优势比为0.13（95%置信区间0.02 - 0.99）。治疗组的感染发病时间明显更短（5天对16.7天；P < 0.001），感染持续时间也更短（8.5天对26.8天；P < 0.001）。最常见的致病菌是铜绿假单胞菌（35.2%）。多变量分析后，患者诊断、手术方式和术中失血量是SSI的重要危险因素。
结论
术中预防性局部应用万古霉素粉末可降低接受脊柱器械手术患者发生SSI的风险和发病率。铜绿假单胞菌感染在治疗组中很常见。建议未来在更大人群中进行涉及其他脊柱手术且随访时间较长的前瞻性随机对照试验。
证据级别
3级
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