短时间使用预防性抗生素对颈椎术后伤口感染的影响

Impact of short-time treatment of prophylactic antibiotics for surgical site infection in cervical spinal surgery

目的探讨短时间预防性使用抗生素对颈椎术后伤口感染的影响。方法回顾性分析2009至2011年行择期颈椎手术的患者965例，根据使用抗生素的种类及时间分为短时间使用预防性抗生素组（A组234例）和经验性使用预防性抗生素组（B组731例）。收集患者一般资料、内科合并疾病病史、手术相关信息、患者围手术期体温及相关检验数据、抗生素使用情况，并收集伤口感染患者资料。结果A组使用二代头孢菌素153例、克林霉素81例，抗生素使用时间（1．2±0．4）d。B组使用青霉素类41例、二代头孢菌素375例、三代头孢菌素2例、克林霉素128例、头霉素类42例、喹诺酮类128例、其他1例、联合用药14例，抗生素使用时间（5．7±1．6）d。抗生素使用时间的差异有统计学意义（P〈0．001）。A、B两组在手术前后白细胞计数差异无统计学意义，术后中性类细胞分类A组70．7％±9．7％，B组67．1％±9．8％，P=0．004，差异有统计学意义，但均在正常参考范围之内，无临床意义。术后伤口感染共7例（0．7％），A组4例（1．7％），B组3例（0．4％），均为颈后路椎管扩大成型术患者，Fisher精确概率法P=0．063，差异无统计学意义。结论对于颈椎手术患者，短时间合理使用预防性抗生素并未增加术后伤口感染的机会。

Objectives This study is designed to determine the impact of the short-time usage of prophylactic antibiotics to prevent postoperative wound infection in spinal surgery. Methods The medical records of 965 patients who underwent cervical spinal operation between 2009 and 2011 were collected for the assessment. These patients were divided into two groups based on antibiotic selection and duration of prophylactic antibiotic treatment：234 patients treated with prophylactic antibiotics for a short period of time were set as Group A, whereas Group B included 731 patients treated with prophylactic antibiotics for experience-based length of time. All the patients＇ records, including personal information, preoperational medical records, surgical records, postoperative medical information and the development of surgical site infections, were collected for analysis. Results In Group A, 153 patients were treated by second generation cephalosporins and 81 patients were treated by clindamycin. The duration of treatment was 1.17 ± 0. 38 days. In Group B, 41 patients were treated by penicillin, 375 and 2 patients were treated by second and third generation cephalosporins, respectively, 128 patients were treated by clindamycin, 42 patients were treated by cephamycin, 128 patients were treated by quinolone, other antibiotic was used by 1 patient and other 14 patients were treated by combinations of antibiotics. The duration of the treatment in Group B was 5.72 ± 1.63 days. The significant differences between the length of treatment time in Group A and B were observed （P 〈 0. 001 ）. There were no statistical differences of pre-/post-operational leukocytes number compared between Group A and B. In addition, although the neutrophils in Group A and B are 70. 70% ±9.71% and 67.09% ±9.78% respectively, indicating a subtle difference （ t = 2.921, P = 0. 004）, however, these numbers were in normal range; therefore, no clinical significance was found from the comparison of neutrophils in groups. A total of 7 cases （0. 73 % ） of surgical site infection were recorded, including 4 cases （ 1.71% ） in Group A and 3 cases （0.41%） in Group B, all of which were posterior laminoplasty. With Fisher analysis （ P = 0. 063 ）, these infection rates were not statistically significant. Conclusions An appropriate usage of prophylactic antibiotics in a short period of time in cervical spinal surgery did not increase the rate of surgical site infection.