Division of Pediatric Orthopaedics, Rainbow Babies and Children's Hospitals/University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH.
Department of Orthopaedics, BC Children's Hospital, Vancouver, British Columbia, Canada.
J Pediatr Orthop. 2022;42(5):280-284. doi: 10.1097/BPO.0000000000002079.
Surgical site infection (SSI) rates in pediatric spinal deformity surgery for cerebral palsy (CP) patients are higher than that in idiopathic scoliosis. The use of vancomycin powder is associated with decreased risk of SSI in neuromuscular patients. Prior studies in adult and pediatric early-onset scoliosis patients have shown that vancomycin powder alters microbacterial profile in patients that develop SSI. However, the effects of topical vancomycin powder on microbiology in spinal deformity surgery for CP patients has not been studied.
An international multicenter database of CP neuromuscular scoliosis patients was used in this retrospective cohort study. All patients that underwent posterior spinal instrumented fusion for CP neuromuscular scoliosis from 2008 to 2019 were queried, and 50 cases complicated by postoperative SSI were identified. Intraoperative antibiotic details were documented in 49 cases (98.0%). Microbiology details were documented in 45 cases (91.8%). Microbiology for patients that received topical vancomycin powder were compared with patients that did not. A multivariate regression model was used to control for potential confounders.
There were 45 patients included in this study. There were 27 males (60.0%) and 18 females (40.0%). Mean age at surgery was 14.8±2.4 years. There were 24 patients that received topical vancomycin powder (53.3%). The mean time from index surgery to SSI was 4.3±11.3 months.On univariate analysis of microbiology cultures by vancomycin powder cohort, there were no significant differences in culture types. Proteus spp. trended on significance with association with vancomycin powder use (P=0.078). When controlling for potential confounders on multivariate analysis, intraoperative topical vancomycin powder was associated with increased risk for proteus infection (adjusted odds ratio: 262.900, 95% confidence interval: 1.806-38,267.121, P=0.028).
In CP patients undergoing pediatric spinal deformity surgery, the use of vancomycin powder was independently associated with increased risk for proteus infections. Further study into antibiotic regimens for spinal deformity surgery in the CP population should be performed.
Level III-retrospective cohort study.
脑瘫（CP）患者行小儿脊柱畸形手术的手术部位感染（SSI）发生率高于特发性脊柱侧凸患者。万古霉素粉末的使用与神经肌肉患者 SSI 风险降低相关。先前在成人和小儿早发性脊柱侧凸患者中的研究表明，万古霉素粉末会改变发生 SSI 的患者的微生物菌群谱。然而，尚未研究 CP 患者脊柱畸形手术中局部万古霉素粉末对微生物学的影响。
本回顾性队列研究使用了 CP 神经肌肉脊柱侧凸患者的国际多中心数据库。对 2008 年至 2019 年间接受 CP 神经肌肉脊柱侧凸后路脊柱器械融合术的所有患者进行了检索，并确定了 50 例术后 SSI 并发症患者。记录了 49 例（98.0%）患者的术中抗生素详细信息。记录了 45 例（91.8%）患者的微生物学详细信息。比较了使用局部万古霉素粉末的患者和未使用局部万古霉素粉末的患者的微生物学情况。使用多变量回归模型控制潜在混杂因素。
本研究共纳入 45 例患者。男性 27 例（60.0%），女性 18 例（40.0%）。手术时的平均年龄为 14.8±2.4 岁。有 24 例患者使用了局部万古霉素粉末（53.3%）。从索引手术到 SSI 的平均时间为 4.3±11.3 个月。根据万古霉素粉末组的微生物培养进行单变量分析，培养类型无显著差异。普罗维登斯菌属有与万古霉素粉末使用相关的趋势（P=0.078）。在多变量分析中控制潜在混杂因素后，术中局部使用万古霉素粉末与普罗维登斯菌感染风险增加相关（调整后的优势比：262.900，95%置信区间：1.806-38，267.121，P=0.028）。
在接受小儿脊柱畸形手术的 CP 患者中，万古霉素粉末的使用与普罗维登斯菌感染风险增加独立相关。应进一步研究 CP 人群脊柱畸形手术的抗生素方案。
III 级-回顾性队列研究。
