Patel Neal, Gold Justin, Brown Nolan J, Abraham Mickey, Beyer Ryan S, Yang Chenyi, Moore Joshua R, Saunders Scott T, Shahrestani Shane, Gendreau Julian, Mammis Antonios
School of Medicine, Mercer University, Columbus, GA, USA.
Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
Neuromodulation. 2023 Jul;26(5):928-937. doi: 10.1016/j.neurom.2022.07.013. Epub 2022 Oct 2.
Staphylococcus aureus (S aureus) is the foremost bacterial cause of surgical-site infection (SSI) and is a common source of neuromodulation SSI. Endogenous colonization is an independent risk factor for SSI; however, this risk has been shown to diminish with screening and decolonization.
A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using the PubMed, Cochrane Library, and Embase data bases from inception to January 1, 2022, for the purposes of identifying all studies reporting on the use of S aureus swabbing and/or decolonization before neuromodulation procedures. A random-effects meta-analysis was performed using the metaphor package in R to calculate odds ratios (OR).
Five observational cohort studies were included after applying the inclusion and exclusion criteria. The average study duration was 6.6 ± 3.8 years. Three studies included nasal screening as a prerequisite for subsequent decolonization. Type of neuromodulation included spinal cord stimulation in two studies, deep brain stimulation in two studies, intrathecal baclofen in one study, and sacral neuromodulation in one study. Overall, 860 and 1054 patients were included in a control or intervention (ie, screening and/or decolonization) group, respectively. A combination of nasal mupirocin ointment and a body wash, most commonly chlorhexidine gluconate soap, was used to decolonize throughout. Overall infection rates were observed at 59 of 860 (6.86%) and ten of 1054 (0.95%) in the control and intervention groups, respectively. Four studies reported a significant difference. The OR for intervention (screen and/or decolonization) vs no intervention was 0.19 (95% CI, 0.09-0.37; p < 0.001). Heterogeneity between studies was nonsignificant (I = 0.43%, τ = 0.00).
Preoperative S aureus swabbing and decolonization resulted in significantly decreased odds of infection in neuromodulation procedures. This measure may represent a worthwhile tool to reduce neuromodulation SSI, warranting further investigation.
金黄色葡萄球菌是手术部位感染（SSI）的首要细菌病因，也是神经调节性SSI的常见来源。内源性定植是SSI的一个独立危险因素；然而，已证明这种风险会随着筛查和去定植而降低。
根据系统评价和Meta分析的首选报告项目指南，对PubMed、Cochrane图书馆和Embase数据库从建库至2022年1月1日的数据进行系统评价，以识别所有报告在神经调节手术前使用金黄色葡萄球菌拭子检查和/或去定植的研究。使用R语言中的metaphor软件包进行随机效应Meta分析，以计算比值比（OR）。
应用纳入和排除标准后，纳入了五项观察性队列研究。平均研究时长为6.6±3.8年。三项研究将鼻腔筛查作为后续去定植的前提条件。神经调节类型包括两项研究中的脊髓刺激、两项研究中的深部脑刺激、一项研究中的鞘内注射巴氯芬以及一项研究中的骶神经调节。总体而言，分别有860例和1054例患者被纳入对照组或干预组（即筛查和/或去定植组）。在整个过程中，使用莫匹罗星鼻软膏和沐浴露（最常用的是葡萄糖酸氯己定皂）联合进行去定植。对照组和干预组的总体感染率分别为860例中的59例（6.86%）和1054例中的10例（0.95%）。四项研究报告了显著差异。干预组（筛查和/或去定植）与未干预组的OR为0.19（95%CI，0.09 - 0.37；p < 0.001）。研究间的异质性不显著（I² = 0.43%，τ² = 0.00）。
术前金黄色葡萄球菌拭子检查和去定植可显著降低神经调节手术中的感染几率。该措施可能是减少神经调节性SSI的一个有价值的工具，值得进一步研究。
