Xiong Grace X, Greene Nattaly E, Hershman Stuart H, Fogel Harold A, Schwab Joseph H, Bono Christopher M, Tobert Daniel G
Harvard Combined Orthopaedic Residency Program.
Massachusetts General Hospital, Boston, MA.
Clin Spine Surg. 2023 Feb 1;36(1):E51-E58. doi: 10.1097/BSD.0000000000001350. Epub 2022 Jun 9.
Retrospective cohort study.
The objective of this study was to determine the relationship between nasal methicillin-resistant Staphylococcus aureus (MRSA) testing and surgical site infection (SSI) rates in the setting of primary posterior cervical instrumented spine surgery.
Preoperative MRSA screening and decolonization has demonstrated success for some orthopedic subspecialties in prevention of SSIs. Spine surgery, however, has seen varied results, potentially secondary to the anatomic and surgical heterogeneity of the patients included in prior studies. Given that prior research has demonstrated greater propensity for gram positive SSIs in the cervical spine, we sought to investigate if MRSA screening would be more impactful in the cervical spine.
Adult patients undergoing primary instrumented posterior cervical procedures from January 2015 to December 2019 were reviewed for MRSA testing <90 days before surgery, preoperative mupirocin, perioperative antibiotics, and SSI defined as operative incision and drainage (I&D) <90 days after surgery. Logistic regression modeling used SSI as the primary outcome, MRSA screening as primary predictor, and clinical and demographic factors as covariates.
This study included 668 patients, of whom MRSA testing was performed in 212 patients (31.7%) and 6 (2.8%) were colonized with MRSA. Twelve patients (1.8%) underwent an I&D. On adjusted analysis, preoperative MRSA testing was not associated with postoperative I&D risk. Perioperative vancomycin similarly had no association with postoperative I&D risk. Notably, 6 patients (50%) grew methicillin sensitive Staphylococcus aureus from intraoperative cultures, with no cases of MRSA.
There was no association between preoperative nasal MRSA screening and SSIs in primary posterior cervical instrumented procedures, nor was there any association between vancomycin or infection rate. Furthermore, there was a preponderance of gram positive infections but none caused by MRSA. Given these findings, the considerable cost and effort associated with MRSA testing in the setting of primary posterior cervical instrumentation may not be justified. Further research should investigate if higher-risk scenarios demonstrate greater utility of preoperative testing.
回顾性队列研究。
本研究的目的是确定在初次后路颈椎器械辅助脊柱手术中，鼻腔耐甲氧西林金黄色葡萄球菌（MRSA）检测与手术部位感染（SSI）发生率之间的关系。
术前MRSA筛查和去定植已在一些骨科亚专业中成功预防了SSI。然而，脊柱手术的结果各不相同，这可能是由于先前研究中纳入患者的解剖学和手术异质性所致。鉴于先前的研究表明颈椎革兰氏阳性SSI的倾向更大，我们试图研究MRSA筛查在颈椎手术中是否更具影响力。
回顾性分析2015年1月至2019年12月接受初次后路颈椎器械辅助手术的成年患者，记录术前<90天的MRSA检测、术前莫匹罗星使用情况、围手术期抗生素使用情况，以及定义为术后<90天手术切口切开引流（I&D）的SSI情况。逻辑回归模型以SSI作为主要结局，MRSA筛查作为主要预测因素，临床和人口统计学因素作为协变量。
本研究纳入668例患者，其中212例（31.7%）进行了MRSA检测，6例（2.8%）为MRSA定植。12例患者（1.8%）接受了I&D。经校正分析，术前MRSA检测与术后I&D风险无关。围手术期使用万古霉素同样与术后I&D风险无关。值得注意的是，6例患者（50%）术中培养出甲氧西林敏感金黄色葡萄球菌，无MRSA病例。
在初次后路颈椎器械辅助手术中，术前鼻腔MRSA筛查与SSI之间无关联，万古霉素使用与感染率之间也无关联。此外，革兰氏阳性感染占优势，但均非由MRSA引起。鉴于这些发现，在初次后路颈椎器械辅助手术中进行MRSA检测所产生的巨大成本和工作量可能不合理。进一步的研究应调查在更高风险的情况下术前检测是否具有更大的效用。
