小儿脊柱畸形手术的手术部位感染预防方案：有效果吗？

Surgical site infection prevention protocol for pediatric spinal deformity surgery: does it make a difference?

作者信息

Poe-Kochert Connie, Shimberg Jilan L, Thompson George H, Son-Hing Jochen P, Hardesty Christina K, Mistovich R Justin

机构信息

Rainbow Babies and Children's Hospital, University Hospitals Cleveland Medical Center, Cleveland, USA.

Case Western Reserve University School of Medicine, Cleveland, USA.

出版信息

Spine Deform. 2020 Oct;8(5):931-938. doi: 10.1007/s43390-020-00120-6. Epub 2020 Apr 30.

DOI:10.1007/s43390-020-00120-6

PMID:32356280

Abstract

STUDY DESIGN

Retrospective.

OBJECTIVE

Can a standardized, hospital-wide care bundle decrease surgical site infection (SSI) rate in pediatric spinal deformity surgery? SSI is a major concern in pediatric spinal deformity surgery.

METHODS

We performed a retrospective review of our primary scoliosis surgeries between 1999 and 2017. In 2008, we implemented a standardized infection reduction bundle. Interventions included preoperative nares screening for methicillin-resistant staphylococcus aureus or methicillin-sensitive Staphylococcus aureus 2 weeks preoperatively, and treatment with intranasal mupirocin when positive, a bath or shower the night before surgery, a preoperative chlorohexidine scrub, timing of standardized antibiotic administration, standardized intraoperative re-dosing of antibiotics, limiting operating room traffic, and standardized postoperative wound care. In 2011, we added intrawound vancomycin powder at wound closure. Our inclusion criteria were patients 21 years of age or less with idiopathic, neuromuscular, syndromic, or congenital scoliosis who had a primary spinal fusion or a same day anterior and posterior spine fusion with segmental spinal instrumentation of six levels or more. We compared the incidence of early (within 90 days of surgery) and late (> 91 days) SSI during the first postoperative year.

RESULTS

There were 804 patients who met inclusion criteria: 404 in the non-bundle group (NBG) for cases prior to protocol change and 400 in the bundle group (BG) for cases after the protocol change. Postoperatively, there were 29 infections (7.2% of total cases) in the NBG: 9 early (2.2%) and 20 late (5.0%) while in the BG there were only 10 infection (2.5%): 6 early (1.5%) and 4 late (1.0%). The reduction in overall SSIs was statistically significant (p = 0.01). There was a trend toward decreased early infections in the BG, without reaching statistical significance (p = 0.14).

CONCLUSION

Standardized care bundles appear effective in reducing the incidence of postoperative pediatric spine SSIs.

LEVEL OF EVIDENCE

Level III.

摘要

研究设计

回顾性研究。

目的

标准化的全院护理集束措施能否降低小儿脊柱畸形手术的手术部位感染（SSI）率？SSI是小儿脊柱畸形手术中的一个主要问题。

方法

我们对1999年至2017年间的原发性脊柱侧弯手术进行了回顾性研究。2008年，我们实施了标准化的感染防控集束措施。干预措施包括术前2周对鼻腔进行耐甲氧西林金黄色葡萄球菌或甲氧西林敏感金黄色葡萄球菌筛查，阳性时使用鼻内莫匹罗星治疗，术前一晚洗澡或淋浴，术前用氯己定擦洗，标准化抗生素给药时间，术中标准化再次给药，限制手术室人员流动，以及标准化术后伤口护理。2011年，我们在伤口闭合时添加了伤口内万古霉素粉末。我们的纳入标准是年龄在21岁及以下，患有特发性、神经肌肉性、综合征性或先天性脊柱侧弯，接受初次脊柱融合手术或同一天前后路脊柱融合手术且节段性脊柱内固定达六级或以上的患者。我们比较了术后第一年早期（手术90天内）和晚期（>91天）SSI的发生率。

结果

有804例患者符合纳入标准：方案变更前的非集束组（NBG）有404例，方案变更后的集束组（BG）有400例。术后，NBG组有29例感染（占总病例的7.2%）：9例早期感染（2.2%）和20例晚期感染（5.0%），而BG组仅有10例感染（2.5%）：6例早期感染（1.5%）和4例晚期感染（1.0%）。总体SSI的降低具有统计学意义（p = 0.01）。BG组早期感染有下降趋势，但未达到统计学意义（p = 0.14）。