聚维酮碘冲洗联合万古霉素粉末可降低小儿矫形外科手术的感染率。
Povidone-iodine irrigation combined with Vancomycin powder lowers infection rates in pediatric deformity surgery.
机构信息
Department of Orthopedics University of California, Davis, Sacramento, USA.
Shriners Hospitals for Children Northern California, Sacramento, CA, USA.
出版信息
Spine Deform. 2021 Sep;9(5):1315-1321. doi: 10.1007/s43390-021-00333-3. Epub 2021 May 10.
BACKGROUND
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.
METHODS
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.
RESULTS
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.
CONCLUSIONS
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 OF EVIDENCE
Level II.
背景
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。
方法
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。
结果
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。
结论
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。
证据等级
2 级。
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