Study Design: 

Retrospective cohort study.

Objective: 

To compare infection rates before and after the implementation of a quality improvement protocol focused on methicillin-resistant Staphylococcus aureus (MRSA) screening and decolonization in patients undergoing lumbar fusion and/or decompression.

Summary of Background Data: 

Prior studies have demonstrated MRSA infections comprise a sizable portion of SSIs. Additional studies are required to improve our understanding of the risks and benefits of MRSA decolonization with vancomycin prophylaxis.

Methods: 

A retrospective cohort analysis was conducted on patients who underwent spinal fusion or laminectomy before (2008–2011) and after (2013–2016) the implementation of an MRSA screening and treatment protocol. Odds ratios for MRSA, methicillin-sensitive Staphylococcus aureus (MSSA), and Vancomycin-resistant Enterococcus (VRE) infection before and after screening was calculated. Multivariate analysis assessed demographic characteristics as potential independent predictors of infection.

Results: 

A total of 8425 lumbar fusion and 2558 lumbar decompression cases met inclusion criteria resulting in a total cohort of 10,983 patients. There was a significant decrease in the overall rate of infections (P <0.001), MRSA infections (P<0.001), and MSSA infections (P<0.001) after protocol implementation. Although VRE infections after protocol implementation were not significantly different (P=0.066), VRE rates as a percentage of all postoperative infections were substantially increased (0 vs. 3.36%, P=0.007). On multivariate analysis, significant predictors of the infection included younger age (OR=0.94[0.92–0.95]), shorter length of procedure (OR=1.00[0.99–1.00]), spinal fusion (OR=18.56[8.22–53.28]), higher ASA class (OR=5.49[4.08–7.44]), male sex (OR=1.61[1.18–2.20]), and history of diabetes (OR=1.58[1.08–2.29]).

Conclusion: 

The implemented quality improvement protocol demonstrated that preoperative prophylactically treating MRSA colonized patients decreased the rate of overall infections, MSSA infections, and MRSA infections. In addition, younger age, male sex, diabetic status, greater ASA scores, and spinal fusions were risk factors for postoperative infection.

中文翻译：

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脊柱手术中 MRSA 预防可减少术后感染

学习规划： 

回顾性队列研究。

客观的： 

比较实施质量改进方案前后的感染率，该方案重点关注接受腰椎融合和/或减压的患者的耐甲氧西林金黄色葡萄球菌( MRSA ) 筛查和去定植。

背景数据摘要： 

先前的研究表明MRSA感染占 SSI 的很大一部分。需要进行更多研究来提高我们对万古霉素预防性MRSA去定植的风险和益处的了解。

方法： 

对实施MRSA筛查和治疗方案之前（2008-2011 年）和之后（2013-2016 年）接受脊柱融合或椎板切除术的患者进行了回顾性队列分析。计算筛查前后MRSA、甲氧西林敏感金黄色葡萄球菌(MSSA) 和万古霉素耐药肠球菌(VRE) 感染的比值比。多变量分析评估了人口特征作为感染的潜在独立预测因素。

结果： 

共有 8425 例腰椎融合病例和 2558 例腰椎减压病例符合纳入标准，总共 10,983 名患者。方案实施后，总体感染率（P <0.001）、MRSA感染率（P <0.001）和MSSA感染率（P <0.001）均显着下降。尽管方案实施后 VRE 感染没有显着差异（P = 0.066），但 VRE 占所有术后感染的百分比却大幅增加（0 vs. 3.36%，P = 0.007）。在多变量分析中，感染的显着预测因素包括年龄较小（OR=0.94[0.92–0.95]）、较短的手术时间（OR=1.00[0.99–1.00]）、脊柱融合（OR=18.56[8.22–53.28]） 、较高 ASA 等级 (OR=5.49[4.08–7.44])、男性 (OR=1.61[1.18–2.20]) 和糖尿病史 (OR=1.58[1.08–2.29])。

结论： 

实施的质量改进方案表明，术前预防性治疗MRSA定植患者可降低总体感染率、MSSA 感染率和MRSA感染率。此外，年龄较小、男性、糖尿病状况、ASA评分较高和脊柱融合是术后感染的危险因素。