Kingdom Hospital and Consulting Clinics, Riyadh, Saudi Arabia.
Saudi Food and Drug Authority, Riyadh, Saudi Arabia.
Antimicrob Resist Infect Control. 2021 Sep 26;10(1):136. doi: 10.1186/s13756-021-01006-6.
The risk of surgical site infections (SSIs), particularly methicillin-resistant Staphylococcus aureus (MRSA) SSIs, after spinal surgeries is one of the most daunting experiences to patients and surgeons. Some authors suggest applying vancomycin powder on the wound before skin closure to minimize the risk of SSIs; however, this practice is not supported by well-established evidence. This study sought to assess the effectiveness of topical (i.e. intra-wound) vancomycin in minimizing the risk of SSIs in patients who underwent spinal surgeries at a Saudi hospital.
A retrospective cohort study was conducted using the hospital database. Patients who underwent spinal surgeries from the period of 09/2013 to 09/2019 were included and followed up (observed from the time of the surgery) to 30 days (surgeries without implants) or 90 days (with implants). The odds ratio (OR) of the primary outcome between vancomycin treated versus non-treated patients was estimated using a logistic regression model adjusting for the measured confounders. A sensitivity analysis was conducted using propensity score analysis (inverse probability of treatment weighting [IPTW] with stabilized weights) to control for confounding by indication. All study analyses were completed using RStudio Version 1.2.5033.
We included 81 vancomycin treated vs. 375 untreated patients with 28 infections (8/81 vs. 20/375; respectively). The adjusted OR of SSIs between the two groups was 0.40 (95% confidence interval [CI] 0.11 to 1.34). The result of the propensity score analysis was consistent (OR: 0.97 [95% CI 0.35 to 2.68]).
We could not find a lower association of SSIs with intra-wound vancomycin in patients who underwent spinal surgeries. Further studies are needed to assess benefits of using topical vancomycin for this indication vs. the risk of antimicrobial resistance.
脊柱手术后手术部位感染（SSI）的风险，尤其是耐甲氧西林金黄色葡萄球菌（MRSA）SSI，是患者和外科医生最担心的问题之一。一些作者建议在皮肤缝合前在伤口上涂抹万古霉素粉末，以降低 SSI 的风险；然而，这种做法并没有得到充分确立的证据支持。本研究旨在评估在沙特一家医院接受脊柱手术的患者中，局部（即伤口内）使用万古霉素是否能有效降低 SSI 的风险。
使用医院数据库进行回顾性队列研究。纳入 2013 年 9 月至 2019 年 9 月期间接受脊柱手术的患者，并进行随访（从手术时开始观察）至 30 天（无植入物的手术）或 90 天（有植入物的手术）。使用逻辑回归模型，根据测量的混杂因素调整，估计主要结局在万古霉素治疗与未治疗患者之间的比值比（OR）。使用倾向评分分析（逆概率治疗加权[IPTW]稳定权重）进行敏感性分析，以控制混杂因素的影响。所有研究分析均使用 RStudio 版本 1.2.5033 完成。
我们纳入了 81 例万古霉素治疗组和 375 例未治疗组患者，共有 28 例感染（81 例中有 8 例，375 例中有 20 例）。两组之间 SSI 的调整 OR 为 0.40（95%置信区间[CI]为 0.11 至 1.34）。倾向评分分析的结果一致（OR：0.97[95%CI 0.35 至 2.68]）。
我们没有发现局部使用万古霉素治疗脊柱手术后 SSI 的风险降低。需要进一步研究评估在这种情况下使用局部万古霉素的益处与抗微生物药物耐药性的风险。
