Taheri Nima, Köhli Paul, Li Zhao, Wang Zhen, Vu-Han Tu-Lan, Cloeren Konstantin, Koch Antonia, Tsitsilonis Serafeim, Schömig Friederike, Khakzad Thilo, Pumberger Matthias
Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 10117 Berlin, Germany.
Berlin Institute of Health, Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité-Universitätsmedizin Berlin, Augustenburger Pl. 1, 13353 Berlin, Germany.
J Pers Med. 2024 Sep 24;14(10):1017. doi: 10.3390/jpm14101017.
Intrawound application of vancomycin is becoming increasingly controversial for the prevention of surgical site infection (SSI). As children undergoing spinal fusion for secondary scoliosis are at high risk for SSIs, evidence regarding the impact of intraoperative vancomycin installation on SSI rates in these patients is of utmost importance. A single surgeon cohort of patients under 18 years of age undergoing surgery for secondary scoliosis in 2017 was analyzed with regard to the development of SSIs requiring surgical revision and adverse events. Use of vancomycin was restricted to cases with higher risk of infection. Patients undergoing distraction surgery for growing devices were excluded. After exclusions, 64 patients remained (vancomycin n = 39, control n = 25). The SSI rates were 12.8% in patients receiving vancomycin (n = 5/39) and 4% in the control group (n = 1/25, = 0.785). None of the patients suffered from adverse events. Univariable logistic regression revealed younger age ( = 0.03) and meningomyelocele as predictors for SSI ( = 0.006), while the high-risk group receiving vancomycin was not at higher odds for SSI, also after adjustment for possible confounders such as age or MMC ( = 0.031; = 0.009). SSI rates were comparable between groups, suggesting a normalization of SSI risk in the vancomycin-treated patients with a preoperatively increased risk of SSI. Future, larger studies in these rare diseases are needed to confirm these results.
万古霉素在伤口内应用以预防手术部位感染（SSI）正变得越来越有争议。由于接受二次脊柱侧弯融合手术的儿童发生SSI的风险很高，因此关于术中应用万古霉素对这些患者SSI发生率影响的证据至关重要。对2017年接受二次脊柱侧弯手术的18岁以下患者的单一外科医生队列进行了分析，以评估需要手术翻修的SSI的发生情况和不良事件。万古霉素的使用仅限于感染风险较高的病例。接受生长棒撑开手术的患者被排除在外。排除后，剩余64例患者（万古霉素组n = 39，对照组n = 25）。接受万古霉素治疗的患者SSI发生率为12.8%（n = 5/39），对照组为4%（n = 1/25，P = 0.785）。没有患者发生不良事件。单因素逻辑回归显示年龄较小（P = 0.03）和脊髓脊膜膨出是SSI的预测因素（P = 0.006），而接受万古霉素治疗的高危组发生SSI的几率并不高，在对年龄或脊髓脊膜膨出等可能的混杂因素进行调整后也是如此（P = 0.031；P = 0.009）。两组之间的SSI发生率相当，这表明术前SSI风险增加的万古霉素治疗患者的SSI风险已正常化。未来需要对这些罕见疾病进行更大规模的研究来证实这些结果。
