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Neurosurgery:局部用万古霉素减少开颅手术后的手术部位感染:一项前瞻性对照研究

发布日期:2018-11-05来源:Neurosurgery官网发布人:感控雏鹰

手术部位感染(SSI)是最常见的医院获得性感染之一。SSI可能与神经外科人群中的大量发病率和死亡率相关。除了可怕的临床后果之外,SSI对成本产生了不利影响,因为医院越来越多地受到寻求减少再入院率和术后并发症的付款人的惩罚。与每例SSI相关的成本通常超过20 000美元和每年30亿美元。改进减少SSI的方法对于改善患者预后并降低医疗费用是势在必行的。

背景

手术部位感染(SSI)是神经外科患者发病率和死亡率的重要原因。局部抗生素是降低这些感染发生率的一种潜在方法。

目的

在一个主要学术中心的一项大型前瞻性队列研究中,检查在开颅术期间应用于伤口内的局部万古霉素的功效。

方法

在该队列研究中,前瞻性地研究了355名患者; 205名患者在子宫下空间接受1g外用万古霉素粉末,而150名匹配的对照患者未接受。患者否则接受相同的护理。主要结果变量是队列考虑的SSI率。二级分析检查了从开颅手术患者的SSI相关的医院费用估算的万古霉素使用成本节省。

结果

局部使用万古霉素与单独使用标准治疗的SSI发生率显着降低相关(0.49%[1/205] vs 6%[9/150],P  = .002)。根据感染翻修手术的费用,外用万古霉素的使用量估计每1000名开颅手术患者可节省1367美元446美元。没有发生不良反应。

结论

外用万古霉素是一种安全,有效且节省成本的措施,可预防开颅术后的SSI。这些结果对开颅手术的标准治疗具有广泛的意义。

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Topical Vancomycin Reduces Surgical-Site Infections After Craniotomy: A Prospective, Controlled Study 

BACKGROUND

Surgical-site infections (SSIs) are an important cause of morbidity and mortality in neurosurgical patients. Topical antibiotics are one potential method to reduce the incidence of these infections.

OBJECTIVE

To examine the efficacy of topical vancomycin applied within the wound during craniotomy in a large prospective cohort study at a major academic center.

METHODS

Three hundred fifty-five patients were studied prospectively in this cohort study; 205 patients received 1 g of topical vancomycin powder in the subgaleal space while 150 matched control patients did not. Patients otherwise received identical care. The primary outcome variable was SSI rate factored by cohort. Secondary analysis examined cost savings from vancomycin usage estimated from hospital costs associated with SSI in craniotomy patients.

RESULTS

The addition of topical vancomycin was associated with a significantly lower rate of SSI than standard of care alone (0.49% [1/205] vs 6% [9/150], P = .002). Based on the costs of revision surgery for infections, topical vancomycin usage was estimated to save $1367 446 per 1000 craniotomy patients. No adverse reactions occurred.

CONCLUSION

Topical vancomycin is a safe, effective, and cost-saving measure to prevent SSIs following craniotomy. These results have broad implications for standard of care in craniotomy.

文章来源:Neurosurgery, Volume 83, Issue 4, 1 October 2018, Pages 761–767,https://doi.org/10.1093/neuros/nyx559

简译人:感控雏鹰