持续局部抗生素灌注治疗脊柱内固定手术后手术部位感染的疗效及局限性：一项回顾性多中心研究
Efficacy and Limitations of Continuous Local Antibiotic Perfusion in Treating Surgical Site Infections Following Instrumented Spinal Surgery: A Retrospective Multicenter Study.
作者信息
Takahashi Hiroshi, Okuyama Kohei, Toki Yasunori, Funayama Toru, Noguchi Hiroshi, Miura Kousei, Gamada Hisanori, Okuwaki Shun, Ogata Yosuke, Sakashita Kotaro, Sunami Takahiro, Nakagawa Takane, Fujii Kengo, Ishikawa Tetsuhiro, Kim Geundong, Ota Mitsutoshi, Inada Taigo, Himeno Daisuke, Takaoka Hiromitsu, Suzuki Masahiro, Maki Satoshi, Inoue Masahiro, Inage Kazuhide, Shiga Yasuhiro, Furuya Takeo, Eguchi Yawara, Orita Sumihisa, Ohtori Seiji, Yamazaki Masashi, Koda Masao
机构信息
Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuoku, Chiba, Chiba, 260-8677, Japan.
出版信息
Infect Dis Ther. 2025 Feb;14(2):421-431. doi: 10.1007/s40121-024-01095-x. Epub 2025 Jan 7.
INTRODUCTION
Surgical site infection (SSI) is one of the most serious postoperative complications following instrumented spinal surgery. We previously reported the potential of continuous local antibiotic perfusion (CLAP) to retain implants for patients with SSI following instrumented spinal surgery. We conducted a retrospective multicenter study to elucidate the efficacy and limitations of CLAP for patients with SSI following instrumented spinal surgery.
METHODS
A total of 40 patients treated with CLAP for SSI after instrumented spinal surgery were included in this study. The implant retention rate was calculated. We investigated the influence of age, presence of diabetes, number of fused vertebrae, causative pathogens, duration from diagnosis to CLAP initiation, white blood cell (WBC) count (× 10/μL), and C-reactive protein (CRP) level on the development of SSI after CLAP. Patients were divided into two groups: a favorable outcome group (n = 28), in which SSI was promptly controlled after CLAP, and a poor outcome group (n = 12), in which additional surgery was required or fatal outcomes occurred after CLAP. The relationship between these two groups was evaluated.
RESULTS
In 13 of 40 patients, implants had already been removed before CLAP initiation. Excluding these cases, control of SSI with implant retention was achieved by CLAP in 22 of 27 patients (81%). In the poor outcome group, antibiotic-resistant pathogens were detected at a higher rate than in the favorable outcome group (p = 0.022), and the WBC counts at 1 week after CLAP were significantly increased compared with the favorable outcome group (poor outcome group 7.7 ± 2.4, favorable outcome group 5.8 ± 1.6; p = 0.013).
CONCLUSIONS
Application of CLAP enabled SSI control with a high rate of implant retention. However, detection of antibiotic-resistant pathogens and increased WBC count 1 week after initiating CLAP may predict poor control of SSI, even after CLAP.
引言
手术部位感染（SSI）是脊柱内固定手术后最严重的术后并发症之一。我们之前报道了持续局部抗生素灌注（CLAP）对于脊柱内固定手术后发生SSI患者保留植入物的可能性。我们进行了一项回顾性多中心研究，以阐明CLAP对脊柱内固定手术后发生SSI患者的疗效和局限性。
方法
本研究纳入了40例脊柱内固定手术后接受CLAP治疗SSI的患者。计算植入物保留率。我们调查了年龄、糖尿病的存在、融合椎体数量、致病病原体、从诊断到开始CLAP的持续时间、白细胞（WBC）计数（×10/μL）和C反应蛋白（CRP）水平对CLAP后SSI发生的影响。患者分为两组：预后良好组（n = 28），CLAP后SSI得到迅速控制；预后不良组（n = 12），CLAP后需要进行额外手术或出现致命结局。评估这两组之间的关系。
结果
40例患者中有13例在开始CLAP之前已经取出了植入物。排除这些病例后，27例患者中有22例（81%）通过CLAP实现了SSI的控制且保留了植入物。在预后不良组中，检测到抗生素耐药病原体的比例高于预后良好组（p = 0.022），并且CLAP后1周时的WBC计数与预后良好组相比显著升高（预后不良组7.7±2.4，预后良好组5.8±1.6；p = 0.013）。
结论
CLAP的应用能够实现SSI的控制且植入物保留率较高。然而，CLAP开始后1周检测到抗生素耐药病原体和WBC计数升高可能预示即使在CLAP后SSI也难以得到良好控制。
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