Department of Orthopedics University of California, Davis, Sacramento, USA.
Shriners Hospitals for Children Northern California, Sacramento, CA, USA.
Spine Deform. 2021 Sep;9(5):1315-1321. doi: 10.1007/s43390-021-00333-3. Epub 2021 May 10.
Surgical site infection is a morbid, devastating complication after spinal procedures. Studies have investigated the effect of wound lavage with 3.5% Povidone-iodine solution or the use of intrawound Vancomycin powder. We examined the effect of Povidone-iodine irrigation, intrawound Vancomycin powder, or a combination of both agents in a tertiary care Pediatric Hospital.
We queried our health system database for patients undergoing spinal surgery over an eight-year span between January 2008 and June 2016 and identified patient cohorts who received no intervention, intrawound Vancomycin alone, Povidone-iodine irrigation alone, or a combination of both agents. Infection rates were determined. The effect of treatment on outcome was analyzed using a logistic regression model.
475 patients were identified who met study inclusion criteria. 88 non-neuromuscular patients received no intra-operative agent. The surgical site infection (SSI) rate in this group of patients was 10%. For the 194 non-neuromuscular scoliosis patients who received Povidone-iodine and Vancomycin powder, the infection rate was reduced to 0.7%. The SSI rate in the 180 non-neuromuscular patients who were treated with Vancomycin powder alone was 1.4%. 13 patients were treated with Povidone-iodine lavage only, with a small sample size precluding statistical comparison. Infection rate in the 132 neuromuscular disease patients decreased from 14 to 7% overall during this time span: while the odds ratio of infection was reduced in all neuromuscular treatment groups receiving intra-operative measures, statistical significance was not reached in any neuromuscular group studied.
A protocol using combined 3.5% weight/volume Povidone-iodine and Vancomycin powder was associated with the lowest infection rate in our non-neuromuscular patient population and should be considered as a low cost intervention in pediatric patients undergoing spinal deformity procedures.
Level II.
手术部位感染是脊柱手术后一种严重且具有破坏性的并发症。已有研究调查了用 3.5%聚维酮碘溶液冲洗伤口或使用伤口内万古霉素粉末的效果。我们在一家三级儿科医院检查了聚维酮碘冲洗、伤口内万古霉素粉末或两者联合应用的效果。
我们在 2008 年 1 月至 2016 年 6 月的八年期间，在我们的医疗系统数据库中查询了接受脊柱手术的患者，并确定了接受无干预、伤口内单独使用万古霉素、聚维酮碘冲洗或两者联合的患者队列。确定感染率。使用逻辑回归模型分析治疗对结果的影响。
确定了 475 名符合研究纳入标准的患者。88 例非神经肌肉患者未接受术中药物治疗。该组患者的手术部位感染（SSI）率为 10%。对于 194 例非神经肌肉脊柱侧凸患者，使用聚维酮碘和万古霉素粉末的感染率降低至 0.7%。单独使用万古霉素粉末治疗的 180 例非神经肌肉患者的 SSI 率为 1.4%。13 例患者仅接受聚维酮碘冲洗治疗，由于样本量小，无法进行统计学比较。在此期间，132 例神经肌肉疾病患者的感染率从 14%降至 7%：虽然接受术中措施的所有神经肌肉治疗组的感染几率都降低了，但在任何研究的神经肌肉组中都未达到统计学意义。
在我们的非神经肌肉患者人群中，使用 3.5%重量/体积聚维酮碘和万古霉素粉末联合方案与最低的感染率相关，应考虑作为接受脊柱畸形手术的儿科患者的低成本干预措施。
2 级。
