Department of Neurosurgery, Çukurova University, School of Medicine, Adana, Turkey.
Department of Neurosurgery, Bahçeşehir University, School of Medicine, İstanbul, Turkey.
Acta Orthop Traumatol Turc. 2021 Jan;55(1):48-52. doi: 10.5152/j.aott.2021.18372.
This study aimed to determine the efficacy of prophylactic use of vancomycin powder against surgical site infections in patients with high-risk conditions who underwent posterior spinal instrumentation.
Data obtained from 209 patients who underwent posterior spinal instrumentation at a single institution from 2014 to 2017 were retrospectively reviewed. Patients were then divided into two groups: control group, including 107 patients (61 females, 46 males; mean age=54 years; age range=16-85 years), and treatment group, including 102 patients (63 females, 39 males; mean age=53 years; age range=14-90 years). All patients received the same standard prophylactic antibiotic regimen. In addition to the prophylactic antibiotic, vancomycin powder was applied locally to the surgical site in the treatment group. All patients were followed up for at least 90 days postoperatively. Infections were categorized as superficial and deep infections. Subgroup analysis of high-risk patients (Syrian refugees) was also performed.
The infection rates were 1.96% (two patients) in the treatment group and 6.54% (seven patients) in the control group. A significant decrease in the infection rates was observed with local vancomycin powder application. Advanced age (>46 years) and prolonged surgical duration (>140 min) were found to be the main risk factors for surgical site infections (p=0.004 and p=0.028, respectively). The infection rates were 3.22% and 8.11% in the treatment and control groups of refugees, respectively. There were three superficial and four deep infections in the control group and one superficial and one deep infection in the treatment group. A dominance of staphylococcus infections was observed in the control group, whereas no significant dominance was observed in the treatment group. Three patients in the control group and one patient in the treatment group received implant removal.
Evidence from this study has revealed that local application of vancomycin powder reduces the rate of surgical site infections after instrumented spinal surgery. The benefit of vancomycin application may be most appreciated in higher risk populations or in clinics with high baseline rates of infection.
Level III, Therapeutic Study.
本研究旨在确定预防性使用万古霉素粉末对接受后路脊柱器械固定的高危患者手术部位感染的疗效。
回顾性分析 2014 年至 2017 年在一家单机构接受后路脊柱器械固定的 209 例患者的数据。患者随后分为两组：对照组，包括 107 例患者（61 例女性，46 例男性；平均年龄=54 岁；年龄范围 16-85 岁）和治疗组，包括 102 例患者（63 例女性，39 例男性；平均年龄=53 岁；年龄范围 14-90 岁）。所有患者均接受相同的标准预防性抗生素方案。除了预防性抗生素外，治疗组还将万古霉素粉末局部应用于手术部位。所有患者均在术后至少 90 天进行随访。感染分为浅表感染和深部感染。还对高危患者（叙利亚难民）进行了亚组分析。
治疗组的感染率为 1.96%（2 例），对照组为 6.54%（7 例）。局部应用万古霉素粉末可显著降低感染率。年龄较大（>46 岁）和手术时间较长（>140 分钟）是手术部位感染的主要危险因素（p=0.004 和 p=0.028）。在难民组中，治疗组的感染率为 3.22%，对照组为 8.11%。对照组有 3 例浅表感染和 4 例深部感染，治疗组有 1 例浅表感染和 1 例深部感染。对照组以葡萄球菌感染为主，治疗组无明显优势。对照组有 3 例患者和治疗组有 1 例患者接受了植入物去除。
本研究结果表明，后路脊柱器械固定术后局部应用万古霉素粉末可降低手术部位感染率。万古霉素应用的益处可能在高危人群或感染基线率较高的诊所中最为明显。
III 级，治疗性研究。
