评估耐甲氧西林金黄色葡萄球菌（MRSA）特异性抗生素预防在神经外科患者中的作用。
Evaluating the role of methicillin-resistant Staphylococcus aureus (MRSA)-specific antibiotic prophylaxis for neurosurgical patients.
机构信息
University of Michigan Medical School, Ann Arbor, MI, USA; Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA.
Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA.
出版信息
Clin Neurol Neurosurg. 2021 Jan;200:106353. doi: 10.1016/j.clineuro.2020.106353. Epub 2020 Nov 3.
OBJECTIVE
Surgical site infection (SSI) in neurosurgical patients increases morbidity. Despite the rise of methicillin-resistant Staphylococcus aureus (MRSA) colonization, there is little consensus regarding antibiotic prophylaxis for SSI in MRSA-colonized neurosurgical patients. Our objective was to examine the incidence of SSI in MRSA-colonized neurosurgical patients and interrogate whether MRSA-specific antibiotic prophylaxis reduces SSIs.
METHODS
We performed a retrospective analysis of adult patients undergoing neurosurgical procedures between 2013 and 2018. The primary outcome was SSI in patients with MRSA colonization receiving MRSA-specific antibiotics. Secondary outcomes included predictors of SSI, including whether broad use of MRSA-specific antibiotics affects SSI rate.
RESULTS
Of 9739 procedures, 376 had SSI (3.9 %). Seven hundred forty-four procedures (7.6 %) were performed on patients screened preoperatively for MRSA, including 54 procedures on MRSA-colonized patients. MRSA-colonized patients were more likely than MRSA-non-colonized patients to receive MRSA-specific antibiotics (35.2 % vs. 17.8 %, p = 0.002) for prophylaxis. Nevertheless, MRSA-colonized patients had higher SSI rates compared to MRSA-non-colonized patients (22.2 % vs. 6.4 %, p = 0.00002). MRSA-colonization led to 3.49 greater odds (95 % CI 1.52-7.65, p = 0.002) of SSI relative to MRSA-non-colonization. MRSA-colonized patients receiving MRSA-specific antibiotics, compared to those receiving non-MRSA-specific antibiotics, had lower SSI rates, but this difference was not statistically significant (15.8 % vs. 25.7 %, p = 0.40). In the non-screened population, those receiving MRSA-specific antibiotics, compared to those receiving non-MRSA-specific antibiotics, had significantly higher SSI rates (6.9 % vs. 3.0 %, p = 0.00001). The use of MRSA-specific antibiotic prophylaxis in the non-screened population increased the odds of SSI (OR 1.90, 95 % CI 1.45-2.46, p = 0.0001).
CONCLUSION
MRSA-colonized neurosurgical patients had a higher SSI rate compared to MRSA-non-colonized patients. While MRSA-specific antibiotics may benefit those with MRSA colonization, the difference in SSI rate between MRSA-colonized patients receiving MRSA-specific antibiotics vs. non-specific antibiotics requires further investigation. The broader use of MRSA-specific antibiotics may paradoxically confer an increased risk of SSI in a non-screened neurosurgical population.
目的
神经外科患者的手术部位感染（SSI）会增加发病率。尽管耐甲氧西林金黄色葡萄球菌（MRSA）定植的上升，但对于 MRSA 定植的神经外科患者的 SSI 预防用抗生素仍存在较少共识。我们的目的是检查 MRSA 定植的神经外科患者的 SSI 发生率，并探讨 MRSA 特异性抗生素预防是否会降低 SSI。
方法
我们对 2013 年至 2018 年间接受神经外科手术的成年患者进行了回顾性分析。主要结局是接受 MRSA 特异性抗生素治疗的 MRSA 定植的神经外科患者中的 SSI。次要结局包括 SSI 的预测因素，包括是否广泛使用 MRSA 特异性抗生素会影响 SSI 发生率。
结果
在 9739 例手术中，有 376 例发生 SSI（3.9%）。744 例（7.6%）手术是在术前对 MRSA 进行筛查的患者中进行的，其中 54 例手术是在 MRSA 定植的患者中进行的。MRSA 定植的患者比 MRSA 非定植的患者更有可能接受 MRSA 特异性抗生素（35.2%比 17.8%，p=0.002）进行预防。然而，与 MRSA 非定植患者相比，MRSA 定植患者的 SSI 发生率更高（22.2%比 6.4%，p=0.00002）。与 MRSA 非定植相比，MRSA 定植导致 SSI 的可能性增加了 3.49 倍（95%CI 1.52-7.65，p=0.002）。与接受非 MRSA 特异性抗生素治疗的患者相比，接受 MRSA 特异性抗生素治疗的 MRSA 定植患者的 SSI 发生率较低，但无统计学意义（15.8%比 25.7%，p=0.40）。在未筛查人群中，与接受非 MRSA 特异性抗生素治疗的患者相比，接受 MRSA 特异性抗生素治疗的患者 SSI 发生率显著更高（6.9%比 3.0%，p=0.00001）。在未筛查人群中使用 MRSA 特异性抗生素预防会增加 SSI 的可能性（OR 1.90，95%CI 1.45-2.46，p=0.0001）。
结论
与 MRSA 非定植患者相比，MRSA 定植的神经外科患者的 SSI 发生率更高。虽然 MRSA 特异性抗生素可能对 MRSA 定植的患者有益，但接受 MRSA 定植的患者中，MRSA 特异性抗生素与非特异性抗生素治疗的 SSI 发生率之间的差异需要进一步研究。在未筛查的神经外科人群中更广泛地使用 MRSA 特异性抗生素可能会带来增加 SSI 的风险。
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