Malone Jason, Lee-Norris Alex, Wynn Austin, Maher Kaitlin, Lovejoy John, Illgenfritz Ryan, Baldwin Margaret, Cadilla Adriana, Farrell Kathryn, Craver Emily
Nemours Children's Hospital, Orlando, FL, USA.
University of Central Florida/HCA Ocala Florida Hospital, Ocala, FL, USA.
J Pediatr Soc North Am. 2024 Dec 9;10:100136. doi: 10.1016/j.jposna.2024.100136. eCollection 2025 Feb.
The impact of surgical site infections in spinal surgery can be profound. Several studies have demonstrated that carriers have an increased risk of surgical site infection (SSI). The current literature shows decreased SSI in the adult population with povidine-iodine (PI) nasal treatment for decolonizing the nares of patients infected with . The goal of this research study was to analyze the isolated effect of presurgical nasal testing and PI application prior to spinal surgery.
This is a retrospective cohort study of children 8 to 18 years of age who underwent posterior spinal fusion from 2018 to 2020 at two standalone academic pediatric hospitals. Both hospitals had the same preoperative surgical bundle except that Group B included testing for and treatment preoperatively if positive. In addition, all patients in Group B received PI nasal decolonization on the day of surgery.
The overall infection rate between both hospitals was identified as 3.4%, with no difference between the two groups. The infection rate was lowest for adolescent idiopathic scoliosis, with a rate of 1.3% and highest for neuromuscular scoliosis, with a rate of 8.2%. Hospital-wide bacterial rates in Group A compared to Group B were higher for all species (33.8% vs 30.1%, = 0.0004), methicillin-sensitive (24.6% vs 13.1 %, < 0.001) but lower for methicillin-resistant (9.2% vs 17%, = 0.02). Postoperative infection culture rates or bacterium types were not significantly different between the two groups.
The treatment of patients with PI nasal decolonization in the pediatric spinal fusion cohort did not show a decrease in postoperative infections. The PI nasal testing and treatment was $308.25 per patient and $189,580.75 over the study period. Elimination of intranasal testing and treatment result in cost savings and eliminates an unpleasant patient experience.
(1)The treatment of patients with povidine-iodine (PI) nasal decolonization in a pediatric spinal fusion cohort did not show a decrease in postoperative infections.(2)Elimination of intranasal testing and treatment in a pediatric spinal fusion cohort results in cost savings and reduces an unpleasant experience for the patient.(3)Increased surgical time during posterior spinal fusion in a pediatric cohort of patient did not lead to an increased rate of surgical site infection (SSI).(4)Across the cohort of pediatric patient undergoing posterior spinal fusion (PSF), the rate of infection for adolescent idiopathic scoliosis (AIS) patients was 1.3% compared with 8.2% infection rate in patients with neuromuscular scoliosis (NMS).
Level III.
手术部位感染对脊柱手术的影响可能很大。多项研究表明，携带者发生手术部位感染（SSI）的风险增加。当前文献显示，使用聚维酮碘（PI）进行鼻腔治疗以使感染患者的鼻腔去定植，可降低成年人群的SSI。本研究的目的是分析脊柱手术前进行鼻腔检测和应用PI的单独效果。
这是一项回顾性队列研究，研究对象为2018年至2020年在两家独立的学术性儿科医院接受后路脊柱融合术的8至18岁儿童。两家医院的术前手术方案相同，不同之处在于B组术前进行检测，若结果为阳性则进行治疗。此外，B组所有患者在手术当天接受PI鼻腔去定植治疗。
两家医院的总体感染率为3.4%，两组之间无差异。青少年特发性脊柱侧凸的感染率最低，为1.3%，神经肌肉型脊柱侧凸的感染率最高，为8.2%。A组的全院细菌感染率在所有菌种方面均高于B组（33.8%对30.1%，P = 0.0004），对甲氧西林敏感菌（24.6%对13.1%，P < 0.001），但对耐甲氧西林菌较低（9.2%对17%，P = 0.02）。两组术后感染培养率或细菌类型无显著差异。
在小儿脊柱融合队列中，对患者进行PI鼻腔去定植治疗并未降低术后感染率。PI鼻腔检测和治疗的费用为每位患者308.25美元，在研究期间总计189,580.75美元。取消鼻腔检测和治疗可节省成本，并消除患者不愉快的体验。
（1）在小儿脊柱融合队列中，对患者进行聚维酮碘（PI）鼻腔去定植治疗并未降低术后感染率。（2）在小儿脊柱融合队列中取消鼻腔检测和治疗可节省成本，并减少患者不愉快的体验。（3）在小儿患者队列中，后路脊柱融合术期间手术时间增加并未导致手术部位感染（SSI）率升高。（4）在接受后路脊柱融合术（PSF）的小儿患者队列中，青少年特发性脊柱侧凸（AIS）患者的感染率为1.3%，而神经肌肉型脊柱侧凸（NMS）患者的感染率为8.2%。
三级。
