纤维蛋白胶混悬万古霉素局部给药预防脊柱内固定术后手术部位感染的效果：基于治疗权重模型概率的比较。
The Effect of Local Administration of Vancomycin Suspended in Fibrin Glue for Prevention of Surgical Site Infection After Spinal Instrumentation: Comparison by Probability of Treatment Weighting Model.
机构信息
Department of Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, Japan.
Yokohama City University, Yokohama City, Kanagawa, Japan.
出版信息
Spine (Phila Pa 1976). 2023 Mar 15;48(6):384-390. doi: 10.1097/BRS.0000000000004561. Epub 2022 Dec 28.
STUDY DESIGN
A retrospective cohort study.
OBJECTIVE
To compare the surgical site infection (SSI) rate in patients undergoing spinal instrumentation surgery who received vancomycin suspended in fibrin glue at the surgical site and those who did not.
SUMMARY OF BACKGROUND DATA
The intrawound application of vancomycin powder for preventing SSI after spinal surgery remains controversial. Vancomycin suspended in fibrin glue is another option for local administration that may be effective. The present study assessed whether vancomycin suspended in fibrin glue could prevent SSI after spinal instrumentation surgery.
MATERIALS AND METHODS
We enrolled patients who underwent posterior spinal instrumentation surgery with or without fusion for degenerative conditions, spinal trauma, or tumor. A multiple logistic regression model with inverse probability of treatment weighting based on propensity score was used to assess the efficacy of vancomycin suspended in fibrin glue and to account for confounding. A secondary multivariate logistic regression analysis was performed to identify the risk factors associated with SSI.
RESULTS
Of the 264 patients enrolled in this study, 134 underwent application of vancomycin suspended in fibrin glue at the surgical site and 130 did not. The incidence of SSI was lower in patients who were treated with vancomycin suspended in fibrin glue (2.2% vs. 8.5%) even after inverse probability of treatment weighting adjustment (adjusted odds ratio: 0.25; 95% CI, 0.0768-0.91; P =0.03). Multivariate logistic regression analysis showed that the treatment with vancomycin suspended in fibrin glue was significantly associated with a lower odds of SSI (odds ratio: 0.2; 95% CI, 0.05-0.85; P =0.03).
CONCLUSIONS
The administration of vancomycin suspended in fibrin glue was significantly associated with a lower likelihood of SSI in patients undergoing spinal instrumentation surgery.
研究设计
回顾性队列研究。
目的
比较在接受脊柱内固定手术的患者中，局部应用黏附型万古霉素的患者与未应用黏附型万古霉素的患者手术部位感染（SSI）发生率的差异。
背景资料概要
万古霉素粉末局部应用预防脊柱手术后 SSI 的效果仍存在争议。黏附型万古霉素是另一种局部应用的选择，可能有效。本研究评估了黏附型万古霉素是否能预防脊柱内固定手术后 SSI。
材料与方法
我们纳入了因退行性疾病、脊柱创伤或肿瘤行后路脊柱内固定术且行或不行融合术的患者。采用基于倾向评分的逆概率处理加权多变量逻辑回归模型评估黏附型万古霉素的疗效，并校正混杂因素。同时进行了二次多变量逻辑回归分析，以确定与 SSI 相关的危险因素。
结果
本研究共纳入 264 例患者，其中 134 例患者在手术部位应用黏附型万古霉素，130 例患者未应用。即使在进行逆概率处理加权调整后，黏附型万古霉素组 SSI 发生率（2.2%比 8.5%）仍较低（校正优势比：0.25；95%置信区间，0.0768-0.91；P =0.03）。多变量逻辑回归分析显示，黏附型万古霉素治疗与 SSI 发生率降低显著相关（优势比：0.2；95%置信区间，0.05-0.85；P =0.03）。
结论
在接受脊柱内固定手术的患者中，局部应用黏附型万古霉素与 SSI 发生率降低显著相关。
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