| Objective:Local application of antibiotics can accurately deliver the drug to the desired site and form several times the concentration of the drug when systemicallyadministered antibiotics.It can maintain effective concentration for a relatively long period of time locally,and the systemic blood circulation drug concentration is low.Topical use can ensure that there is enough antibiotics in the dead space or blood clots at the place of origin of the infection.At present,most studies show that when spinal surgery is performed,regardless of whether the surgical site is in the cervical spine,thoracic spine,or lumbar spine,the use of a certain amount of vancomycin locally in the wound can effectively reduce the surgical site infection.However,there are still many problems in the local use of vancomycin in the prevention and treatment of SSI,such as local metabolism of drugs,potential drug-related risks,etc.In this study,vancomycin powder and vancomycin cement sticks were used locally in the incisions of lumbar vertebrae to observe changes in vancomycinconcentration and antibacterial activity in the postoperative serum and incision drainage fluids,and to compare the use of 1 g of Vanilla The local drug release pattern of 1g of vancomycin and the use of vancomycin in the local application of vancomycin to prevent the incision infection.Method:A total of 62 lumbar degenerative diseases(including lumbar disc herniation,lumbar spinal stenosis,lumbar spondylolisthesis,etc.)were collected from May 2017 to October 2017.Routine use of posterior lumbar spine,decompression of the lamina,intervertebral space Bone fusion,nail rod system internal fixation.Including 37 males and 25 females,the average age is 61.2±9.4 years old.Grouping situation: From May to June 2017,the lumbar posterior perioperative infection prevention program was combined with the case of local application of vancomycin powder 1g to group A(n=14),July 2017 To August 2017,the lumbar posterior perioperative infection prevention program was combined with topical application of PMG bone cement mixed with 1g of vancomycin into Group B(n=20).From Septeberl 2017 to October2017,cases of posterior lumbar perioperative prophylactic infections were included in group C(n=28).In the groups A and B,the drainage fluid was taken as a sample at 0.5 hours,1 hour,1.5 hours,2 hours,4 hours,6 hours,12 hours,24 hours,and 36 hours after operation,and the amount of drainage fluid was recorded.Replace the drainage bag half an hour before drainage.A and B groups were collected from the same nurse by 3ml blood 1 day,2 days,3 days,4 days,5 days,6 days,7 days,and 1 month after operation.Drainage fluid and blood numbers were collected and stored at-2°C.The drug concentration in the above liquid was measured simultaneously.The MIC was determined by broth dilution method.The minimum inhibitory concentration(MIC)of vancomycin hydrochloride against Staphylococcus aureus was determined.The determination of the concentration of vancomycin hydrochloride in patients after the determination of the external inhibitory concentration of the drainage liquid to determine the minimum inhibitory concentration(MIC)of drainage fluid.Normally distributed measurement data are described by ±x±s,and t-tests are used for comparison between groups.The categorical variable data are described by percentages,and the comparison between groups is by X2 test.Three groups were compared for gender,age,BMI,comorbidity(hypertension,diabetes),smoking,intraoperative blood loss,operative time,drainage tube placement time,etc.,whether the difference was statistically significant.Compare group A and B incisions and group CIncision infection.Result:1.The study included a total of 62 patients.Group A included 14 patients,Group B included 20 patients,and Group C included 28 patients.There was no significant difference in gender,age,BMI,comorbidity(hypertension,diabetes),smoking,intraoperative blood loss,operation time,drainage tube placement time between the three groups(P>0.05).There was no significant difference in the overall characteristics of the patients.2.In all three groups,a total of 4 patients had SSI after surgery,all of which were in group C.Both were staph infections.The infection rate in group A and B wassignificantly lower than that in group C,and the difference was statistically significant(P<0.05).3.The MIC of vancomycin hydrochloride in the drug-containing drainage fluid was 4ug/ml.The results showed that the concentration of vancomycin hydrochloride in the drainage fluid was more than 4ug/ml.In both groups A and B,drainage fluids were sampled for bacterial culture.No pathogens were detected,which was consistent with the in vitro antibacterial test results.In group C,drainage fluid was sampled for bacterial culture,and bacterial colonies were visible.4.Serum vancomycin peaked at 1 day after operation in Group A,and then decreased gradually.After 5 days,the serum vancomycin level was not detected.There was no linear relationship between postoperative concentration and time(Prediction slope: 0.7ug / ml per hour;95% CI-0.11),P = 0.09).Serum vancomycin levels in group B decreased rapidly in the first 3 days and serum drug concentrations stabilized gradually after 4 days,but the postoperative concentration was not correlated with time(slope of prediction: 0.07 ug per hour;95% CI 0.02-0.12,P = 0.08),and the serum drug concentration was higher than that of A group.The concentration of vancomycin in group A was strongly consistent with the time,and the concentration of drug in the group A decreased exponentially.The half-life of drug was 10.2 hours(95% CI 8.2-11.3,P <0.03).The concentration of vancomycin in the drainage fluid of group B reached the peak at 2h,then stabilized,and the concentration of vancomycin did not show a linear relationship with time.Conclusion:Both topical application of vancomycin powder and vancomycin cement sticks can produce locally higher drug concentrations,safe and effective prevention of incision infections,and low systemic drug concentrations to avoid systemic adverse drug reactions.Vancomycin powder can maintain relatively high drug concentration,but the local drug metabolism rate is fast.The vancomycin cement sticks can sustain locally relatively low effective drug concentrations. |
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