Vankomisin Spinal Cerrahide Enfeksiyon İhtimalini Gerçekten Azaltıyor Mu

Year 2022, Volume: 7 Issue: 3, 538 - 547, 01.12.2022

Yunus Demirtaş Levent Çelebi

https://doi.org/10.25279/sak.822635

Abstract

Amaç: Spinal cerrahi morbiditesi ve mortalitesi yüksek cerrahi prosedürlerdendir. Günümüzde cerrahi tekniklerin gelişmesine rağmen spinal cerrahide yara yeri enfeksiyonu halen önemli bir sorun olarak karşımıza çıkmaktadır. Yara yeri enfeksiyonunu engellemek için lokal vankomisin kullanımı bir çok çalışmada araştırılmış net bir sonuca ulaşılamamıştır. Biz bu çalışmada yara yeri enfeksiyonundan korunmak için proflaktik olarak yara yerine lokal vankomisin kullanılan hastalar ile kullanılmayan hastaların sonuçlarını değerlendirdik.
Gereç ve yöntemler: Spinal cerrahi uygulanmış toplam 36 hasta retrospektif olarak değerlendirildi. Bu hastaların demografik verilerine hastane kayıt sisteminden ulaşılarak kaydedildi. Lokal olarak Vankomisin uygulanan hastalar ve uygulanmayan hastalar olarak iki gruba ayrıldı. Her iki gruptaki hastaların komorbit faktörleri, yaş, cinsiyet, ben kitle endeksi, kan paramatreleri, postoperatif komplikasyonları ve yara yeri enfeksiyonları açısından karşılaştırıldı.
Bulgular: Her iki grubun demografik verilerinin dağılımı, komplikasyonları arasında fark yoktu.(p>0.05) Her iki grubun yara yeri enfeksİyonları karşılaştırıldığında aralarında fark olmadığı saptandı.(p>0.05)
Sonuçlar ve öneriler: Lokal vankomisin uygulamasının yara yeri enfeksiyon ihtimalini azaltmadığını düşünmekteyiz. Dahası dirençli mikroorganzimalarının gelişimine sebep olacağı kanaatindeyiz.

Keywords

SPİNAL CERRAHİ, VANKOMİSİN KULLANILMASI, YARA YERİ ENFEKSİYONU

Does Vankomisin Decreases İnfection in Spinal Suregery?

Abstract

İntroduction:Spinal surgery is one of the surgical procedures with high morbidity and mortality. Despite the advances in surgical techniques, wound infection is still an important problem in spinal surgery, The use of local Vancomycin to prevent wound infection has been investigated in many studies, and no clear result has been reached. In this study, we evaluated the results of patients who received vancomycin prophylactically instead of wound and those who were not used to prevent wound infection.
Material and methods: A total of 36 patients who underwent spinal surgery were evaluated retrospectively. The demographic data of these patients were accessed from the hospital registry system and recorded. The patients were divided into two groups as Vancomycin applied and not applied locally. The patients in both groups were compared in terms of comorbid factors, age, gender, body mass index, blood parameters, postoperative complications and wound infections.
Results: There was no difference between the distribution of demographic data and complications of both groups. (p> 0.05) When wound infections of both groups were compared, no difference was found between them. (p> 0.05)
Conclusion: We think that local vancomycin administration does not reduce the possibility of wound infection. Moreover, we believe that it will cause the development of resistant microorganisms.

Keywords

SPİNAL SURGERY, USE VANCOMYCİNE, SURGİCAL SİTE İNFECTİON

References

• Adhikari, P., Nabiyev, V. N., Bahadir, S., Ayhan, S., Yuksel, S., Palaoglu, S., & Acaroglu, E. (2020). Does the Application of Topical Intrawound Vancomycin Powder Affect Deep Surgical Site Infection and the Responsible Organisms after Spinal Surgery?: A Retrospective Case Series with a Historical Control Group. Asian Spine J, 14(1), 72-78. doi: 10.31616/asj.2018.0298
• Bakhsheshian, J., Dahdaleh, N. S., Lam, S. K., Savage, J. W., & Smith, Z. A. (2015). The use of vancomycin powder in modern spine surgery: systematic review and meta-analysis of the clinical evidence. World Neurosurg, 83(5), 816-823. doi: 10.1016/j.wneu.2014.12.033
• Borkhuu, B., Borowski, A., Shah, S. A., Littleton, A. G., Dabney, K. W., & Miller, F. (2008). Antibiotic-loaded allograft decreases the rate of acute deep wound infection after spinal fusion in cerebral palsy. Spine (Phila Pa 1976), 33(21), 2300-2304. doi: 10.1097/BRS.0b013e31818786ff
• Buchholz, H. W., & Engelbrecht, H. (1970). [Depot effects of various antibiotics mixed with Palacos resins]. Chirurg, 41(11), 511-515.
• Buttaro, M. A., Guala, A. J., Comba, F., Suarez, F., & Piccaluga, F. (2010). Incidence of deep infection in aseptic revision THA using vancomycin-impregnated impacted bone allograft. Hip Int, 20(4), 535-541. doi: 10.1177/112070001002000419
• Edin, M. L., Miclau, T., Lester, G. E., Lindsey, R. W., & Dahners, L. E. (1996). Effect of cefazolin and vancomycin on osteoblasts in vitro. Clin Orthop Relat Res(333), 245-251.
• Holtom, P. D., Pavkovic, S. A., Bravos, P. D., Patzakis, M. J., Shepherd, L. E., & Frenkel, B. (2000). Inhibitory effects of the quinolone antibiotics trovafloxacin, ciprofloxacin, and levofloxacin on osteoblastic cells in vitro. J Orthop Res, 18(5), 721-727. doi: 10.1002/jor.1100180507
• Isefuku, S., Joyner, C. J., & Simpson, A. H. (2003). Gentamicin may have an adverse effect on osteogenesis. J Orthop Trauma, 17(3), 212-216. doi: 10.1097/00005131-200303000-00010
• Kirkland, K. B., Briggs, J. P., Trivette, S. L., Wilkinson, W. E., & Sexton, D. J. (1999). The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol, 20(11), 725-730. doi: 10.1086/501572
• Klevens, R. M., Morrison, M. A., Nadle, J., Petit, S., Gershman, K., Ray, S., . . . Fridkin, S. K. (2007). Invasive methicillin-resistant Staphylococcus aureus infections in the United States. Jama, 298(15), 1763-1771. doi: 10.1001/jama.298.15.1763
• Kunakornsawat, S., Sirikajohnirun, S., Piyaskulkaew, C., Pruttikul, P., Kittithamvongs, P., Pongpinyopap, W., & Pluemvitayaporn, T. (2019). Comparison between 1 g and 2 g of Intrawound Vancomycin Powder Application for Prophylaxis in Posterior Instrumented Thoracic or Lumbosacral Spine Surgery: A Preliminary Report. Asian J Neurosurg, 14(3), 710-714. doi: 10.4103/ajns.AJNS_294_17
• Moise, P. A., Smyth, D. S., El-Fawal, N., Robinson, D. A., Holden, P. N., Forrest, A., & Sakoulas, G. (2008). Microbiological effects of prior vancomycin use in patients with methicillin-resistant Staphylococcus aureus bacteraemia. J Antimicrob Chemother, 61(1), 85-90. doi: 10.1093/jac/dkm445
• Neoh, H. M., Hori, S., Komatsu, M., Oguri, T., Takeuchi, F., Cui, L., & Hiramatsu, K. (2007). Impact of reduced vancomycin susceptibility on the therapeutic outcome of MRSA bloodstream infections. Ann Clin Microbiol Antimicrob, 6, 13. doi: 10.1186/1476-0711-6-13
• Noskin, G. A., Rubin, R. J., Schentag, J. J., Kluytmans, J., Hedblom, E. C., Jacobson, C., . . . Bharmal, M. (2007). National trends in Staphylococcus aureus infection rates: impact on economic burden and mortality over a 6-year period (1998-2003). Clin Infect Dis, 45(9), 1132-1140. doi: 10.1086/522186
• O'Neill, K. R., Smith, J. G., Abtahi, A. M., Archer, K. R., Spengler, D. M., McGirt, M. J., & Devin, C. J. (2011). Reduced surgical site infections in patients undergoing posterior spinal stabilization of traumatic injuries using vancomycin powder. Spine J, 11(7), 641-646. doi: 10.1016/j.spinee.2011.04.025
• Perry, A. C., Prpa, B., Rouse, M. S., Piper, K. E., Hanssen, A. D., Steckelberg, J. M., & Patel, R. (2003). Levofloxacin and trovafloxacin inhibition of experimental fracture-healing. Clin Orthop Relat Res(414), 95-100. doi: 10.1097/01.blo.0000087322.60612.14
• Rechtine, G. R., Bono, P. L., Cahill, D., Bolesta, M. J., & Chrin, A. M. (2001). Postoperative wound infection after instrumentation of thoracic and lumbar fractures. J Orthop Trauma, 15(8), 566-569. doi: 10.1097/00005131-200111000-00006
• Slullitel, P. A., Onativia, J. I., Buttaro, M. A., Sanchez, M. L., Comba, F., Zanotti, G., & Piccaluga, F. (2018). State-of-the-art diagnosis and surgical treatment of acute peri-prosthetic joint infection following primary total hip arthroplasty. EFORT Open Rev, 3(7), 434-441. doi: 10.1302/2058-5241.3.170032
• Soriano, A., Marco, F., Martinez, J. A., Pisos, E., Almela, M., Dimova, V. P., . . . Mensa, J. (2008). Influence of vancomycin minimum inhibitory concentration on the treatment of methicillin-resistant Staphylococcus aureus bacteremia. Clin Infect Dis, 46(2), 193-200. doi: 10.1086/524667
• Sweet, F. A., Roh, M., & Sliva, C. (2011). Intrawound application of vancomycin for prophylaxis in instrumented thoracolumbar fusions: efficacy, drug levels, and patient outcomes. Spine (Phila Pa 1976), 36(24), 2084-2088. doi: 10.1097/BRS.0b013e3181ff2cb1
• Tubaki, V. R., Rajasekaran, S., & Shetty, A. P. (2013). Effects of using intravenous antibiotic only versus local intrawound vancomycin antibiotic powder application in addition to intravenous antibiotics on postoperative infection in spine surgery in 907 patients. Spine (Phila Pa 1976), 38(25), 2149-2155. doi: 10.1097/brs.0000000000000015