Emergency Department, Shenzhen People's Hospital, The Second Medical College of Jinan University, Shenzhen, China.
Department of Pediatrics, Futian Women and Children Health Institute, Shenzhen, China.
Br J Neurosurg. 2024 Apr;38(2):481-485. doi: 10.1080/02688697.2021.1902472. Epub 2021 Mar 23.
This study aims to evaluate the effectiveness of gentamycin irrigation in preventing postoperative surgical site infection (SSI) in emergency neurosurgical procedures.
A total of 518 consecutive emergency neurosurgeries, including craniotomies, endoscopic and burr hole procedures were reviewed retrospectively. Patients received either only normal saline (NS) irrigation or NS irrigation with gentamycin added (80 mg/L) during the whole process of surgery. SSIs including wound infection and intracranial infection were the primary outcome. SSI was considered while purulence was observed during wound dressing and confirmed with bacterial culture of wound exudation. In addition, positive result of bacterial growth culture of cerebrospinal fluid was also considered as infection. Infection rates were calculated 28 days after surgery. Statistical analysis was performed using test or Chi-squared test where appropriate.
This study included 444 patients. Gentamycin was used in 179 (40.3%) patients. Only 2 (1.1%) of 179 patients receiving gentamycin irrigation had an infection. However, among the other 265 patients receiving only NS irrigation, the infection rate was 8.3%. With the addition of gentamycin, the infection rate was decreased by 86.7% (=0.001). The two infected patients in gentamycin group were compromised postoperatively: one patient had removed his own extraventricular drainage tube accidentally due to restlessness, and the other had severely contaminated his wound with vomitus during the intracranial drainage tube removal process. If these two patients were excluded from analysis, the effective infection rate using gentamycin irrigation is 0%.
The gentamycin plus NS irrigation during emergency neurosurgical procedures can lead to a significantly lower rate of postoperative infection than when NS is used alone.
本研究旨在评估庆大霉素冲洗在预防急诊神经外科手术部位感染（SSI）中的效果。
回顾性分析了 518 例连续急诊神经外科手术，包括开颅术、内镜和骨孔手术。患者在整个手术过程中接受生理盐水（NS）冲洗或 NS 加庆大霉素（80mg/L）冲洗。SSI 包括伤口感染和颅内感染，为主要结局。当伤口敷料时观察到脓液，并通过伤口渗出物的细菌培养证实时，考虑 SSI。此外，还考虑脑脊液细菌生长培养阳性结果为感染。术后 28 天计算感染率。使用 检验或适当的卡方检验进行统计分析。
本研究包括 444 例患者。庆大霉素用于 179 例（40.3%）患者。仅 179 例接受庆大霉素冲洗的患者中有 2 例（1.1%）发生感染。然而，在接受仅 NS 冲洗的 265 例患者中，感染率为 8.3%。加入庆大霉素后，感染率降低了 86.7%（=0.001）。庆大霉素组的 2 例感染患者术后情况不佳：1 例患者因躁动自行拔出脑室引流管，另 1 例患者在颅内引流管拔出过程中呕吐物严重污染伤口。如果将这两名患者从分析中排除，庆大霉素冲洗的有效感染率为 0%。
与单独使用 NS 相比，庆大霉素加 NS 冲洗在急诊神经外科手术中可显著降低术后感染率。
