Department of Neurosurgery, Medstar Georgetown University Hospital, Washington, DC.
Georgetown University School of Medicine, Washington, DC.
Spine (Phila Pa 1976). 2021 Oct 15;46(20):E1077-E1082. doi: 10.1097/BRS.0000000000004031.
Retrospective cohort study.
The aim of the current investigation was to evaluate the impact of prolonged prophylactic systemic antibiotics (PPSA) on the development of surgical site infection rate (SSIR) in degenerative spine surgery.
Surgical drains are utilized postoperatively in posterior spine surgery to help minimize the risk of seroma formation. Prophylactic antibiotics while drains are in place are frequently used to reduce SSIR, though the practice remains controversial.
We performed a single center, retrospective review of all patients that underwent posterior spinal surgery for cervical and lumbar degenerative pathology over a 3.5 year period (January 2016-July 2019). Patients underwent a traditional open posterior midline procedure with postoperative placement of a subfascial surgical drain. Antibiotics were administered for the duration of the drain (PPSA group) or for 24 hours postoperatively (non-PPSA group). The number of surgical site infections, organism, and Clostridium difficile infections was recorded.
Three hundred thirty six patients were identified, 168 patients in the PPSA group and 168 in the non-PPSA groups. The overall SSIR was 5.36% (18/336). The SSIR for the non-PPSA and PPSA groups were 7.14% (12/168) and 3.57% (6/168), respectively (P = 0.146). While difference of SSIR between the groups was two-fold, it was not statistically significant. For the non-PPSA and PPSA groups, the SSIR for cervical (5.95% [5/84] vs. 2.38% [2/84], P = 0.443) and lumbar (8.33% [7/84], vs. 4.76% [4/84], P = 0.535) regions were not significantly different. C. difficile cases in the PPSA and non-PPSA groups were 1/168 and 0/168 respectively (P = 1.00).
Our series demonstrate a two-fold reduction of SSI with implementation of PPSA regimen. This benefit was demonstrated separately for both cervical and lumbar regions. Randomized trials and increase in sample size are warranted to elucidate the significance of PPSA in posterior spinal surgery.Level of Evidence: 3.
回顾性队列研究。
本研究旨在评估延长预防性全身抗生素（PPSA）对退行性脊柱手术部位感染率（SSIR）发展的影响。
后路脊柱手术后常使用术后引流管以帮助降低血清肿形成的风险。预防性抗生素与引流管一起使用常用于降低 SSIR，但这种做法仍存在争议。
我们对 3.5 年内（2016 年 1 月至 2019 年 7 月）因颈椎和腰椎退行性病变接受后路脊柱手术的所有患者进行了单中心回顾性研究。患者接受传统的后路中线切开术，术后放置筋膜下手术引流管。抗生素的使用时间为引流管放置期间（PPSA 组）或术后 24 小时（非 PPSA 组）。记录手术部位感染的数量、病原体和艰难梭菌感染。
共纳入 336 例患者，其中 PPSA 组 168 例，非 PPSA 组 168 例。总的 SSIR 为 5.36%（18/336）。非 PPSA 组和 PPSA 组的 SSIR 分别为 7.14%（12/168）和 3.57%（6/168）（P=0.146）。尽管两组 SSIR 差异为两倍，但无统计学意义。对于非 PPSA 组和 PPSA 组，颈椎（5.95%[5/84]vs.2.38%[2/84]，P=0.443）和腰椎（8.33%[7/84]，vs.4.76%[4/84]，P=0.535）区域的 SSIR 无显著差异。PPSA 组和非 PPSA 组的艰难梭菌感染病例分别为 1/168 和 0/168（P=1.00）。
我们的研究系列表明，实施 PPSA 方案可将 SSI 降低两倍。这种益处分别在颈椎和腰椎区域得到了证实。需要进行随机试验和增加样本量，以阐明 PPSA 在后路脊柱手术中的意义。
3 级。
