scholarly journals Effectiveness of topical vancomycin in the prevention of spinal surgical site infections: a retrospective cohort study

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Rawan T. Tafish ◽  
Ahmed F. Alkhaldi ◽  
Anouar Bourghli ◽  
Turki A. Althunian
Keyword(s):  
Cohort Study ◽  
Propensity Score ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Propensity Score Analysis ◽  
Surgical Site Infections ◽  
Skin Closure ◽  
Confounding By Indication ◽  
Score Analysis ◽  
Vancomycin Powder

Abstract Background The risk of surgical site infections (SSIs), particularly methicillin-resistant Staphylococcus aureus (MRSA) SSIs, after spinal surgeries is one of the most daunting experiences to patients and surgeons. Some authors suggest applying vancomycin powder on the wound before skin closure to minimize the risk of SSIs; however, this practice is not supported by well-established evidence. This study sought to assess the effectiveness of topical (i.e. intra-wound) vancomycin in minimizing the risk of SSIs in patients who underwent spinal surgeries at a Saudi hospital. Methods A retrospective cohort study was conducted using the hospital database. Patients who underwent spinal surgeries from the period of 09/2013 to 09/2019 were included and followed up (observed from the time of the surgery) to 30 days (surgeries without implants) or 90 days (with implants). The odds ratio (OR) of the primary outcome between vancomycin treated versus non-treated patients was estimated using a logistic regression model adjusting for the measured confounders. A sensitivity analysis was conducted using propensity score analysis (inverse probability of treatment weighting [IPTW] with stabilized weights) to control for confounding by indication. All study analyses were completed using RStudio Version 1.2.5033. Results We included 81 vancomycin treated vs. 375 untreated patients with 28 infections (8/81 vs. 20/375; respectively). The adjusted OR of SSIs between the two groups was 0.40 (95% confidence interval [CI] 0.11 to 1.34). The result of the propensity score analysis was consistent (OR: 0.97 [95% CI 0.35 to 2.68]). Conclusions We could not find a lower association of SSIs with intra-wound vancomycin in patients who underwent spinal surgeries. Further studies are needed to assess benefits of using topical vancomycin for this indication vs. the risk of antimicrobial resistance.

scholarly journals Effectiveness of Topical Vancomycin in the Prevention of Spinal Surgical Site Infections: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Rawan Tafish ◽  
Ahmed F. Alkhaldi ◽  
Anouar Bourghli ◽  
Turki Abdulaziz Althunian
Keyword(s):  
Cohort Study ◽  
Propensity Score ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Propensity Score Analysis ◽  
Surgical Site Infections ◽  
Skin Closure ◽  
Confounding By Indication ◽  
Score Analysis ◽  
Vancomycin Powder

Abstract BackgroundThe risk of surgical site infections (SSIs), particularly methicillin-resistant staphylococcus aureus (MRSA) SSIs, post spinal surgeries is one of the most daunting experiences to patients and surgeons. In some practices, vancomycin powder is applied directly on the wound before skin closure to minimize the risk of SSIs; however, this practice is not supported by well-established evidence. This study sought to assess the effectiveness of topical (i.e. intra-wound) vancomycin in minimizing the risk of SSIs in patients who underwent spinal surgeries at the Kingdom Hospital (a private Saudi hospital).MethodsA retrospective cohort study was conducted using the hospital database. Patients who underwent spinal surgeries from the period of 09/2013 to 09/2019 were included and followed up to 30 days (surgeries without implantation) or 90 days (with implantation). The odds ratio (OR) of the primary outcome between vancomycin users vs. non-users was estimated using logistic regression adjusting for the measured confounders. A sensitivity analysis was conducted using propensity score analysis (inverse probability of treatment weighting (IPTW) with stabilized weights) to control for confounding by indication. All study analyses were completed using RStudio Version 1.2.5033.ResultsWe included 81 vancomycin users vs. 375 non-users with 28 infections. The adjusted OR of SSIs between the two groups was 0.40 (95% confidence interval [CI] 0.11 to 1.34). The result of the propensity score analysis was consistent (OR: 0.97 [95% CI 0.35 to 2.68]). ConclusionWe could not find a lower association of SSIs with intra-wound vancomycin in patients who underwent spinal surgeries. Further studies are needed to assess benefits of using topical vancomycin for this indication vs. the risk of antimicrobial resistance.

scholarly journals Effectiveness of Topical Vancomycin in the Prevention of Spinal Surgical Site Infections: A Retrospective Cohort Study

2021 ◽  
pp. 33
Author(s):  
Rawan Tafish
Keyword(s):  
Cohort Study ◽  
Propensity Score ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Propensity Score Analysis ◽  
Surgical Site Infections ◽  
Skin Closure ◽  
Multicenter Studies ◽  
Score Analysis ◽  
Vancomycin Powder

Introduction: The risk of surgical site infections (SSIs), particularly methicillin-resistant Staphylococcus aureus (MRSA) SSIs, post spinal surgeries is one of the most daunting experiences to patients and surgeons. In some practices, vancomycin powder is applied directly on the wound before skin closure to minimize the risk of SSIs; however, this practice is not supported by well-established evidence. This study sought to assess the effectiveness of topical (intra-wound) vancomycin in minimizing the risk of SSIs in patients who underwent spinal surgeries at a private Saudi hospital. Methodology: A retrospective cohort study was conducted using the hospital database. Patients who underwent spinal surgeries between September 2013 and September 2019 were included and followed-up for up to 30 (for surgeries without implantation) or 90 (for surgeries with implantation) days. The odds ratio (OR) of the first SSI observed in the follow-up period between vancomycin users versus nonusers was estimated using logistic regression adjusting for the measured confounders. A sensitivity analysis was conducted using a propensity score analysis. Result: We included 81 vancomycin users versus 375 nonusers with 28 infections. The adjusted OR of SSIs between the two groups was 0.40 (95% confidence interval [CI] 0.11–1.34). The result of the propensity score analysis was consistent (OR: 0.97 [95% CI 0.35–2.68]). Conclusion: We could not find a lower association of SSIs with intra-wound vancomycin in patients who underwent spinal surgeries. Conducting larger multicenter studies would add more emphasis to the findings of this study. 

Does biologic therapy impact the development of PsA among patients with psoriasis?

2021 ◽  
Vol 81 (1) ◽  
pp. 80-86
Author(s):  
Elana Meer ◽  
Joseph F Merola ◽  
Robert Fitzsimmons ◽  
Thorvardur Jon Love ◽  
Shiyu Wang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Propensity Score ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Oral Therapy ◽  
Biologic Therapy ◽  
Therapy Group ◽  
Time Varying ◽  
Confounding By Indication ◽  
Cox Models

ObjectiveTo examine the association of biologic therapy use for psoriasis with incident psoriatic arthritis (PsA) diagnosis.MethodsA retrospective cohort study was conducted in the OptumInsights Electronic Health Record Database between 2006 and 2017 among patients with psoriasis between the ages of 16 and 90 initiating a therapy for psoriasis (oral, biologic or phototherapy). The incidence of PsA was calculated within each therapy group. Multivariable Cox models were used to calculate the HR for biologic versus oral or phototherapy using biologics as a time-varying exposure and next in a propensity score-matched cohort.ResultsAmong 1 93 709 patients with psoriasis without PsA, 14 569 biologic and 20 321 cumulative oral therapy and phototherapy initiations were identified. Mean age was lower among biologic initiators compared with oral/phototherapy initiators (45.9 vs 49.8). The incidence of PsA regardless of therapy exposure was 9.75 per 1000 person-years compared with 77.26 among biologic users, 61.99 among oral therapy users, 26.11 among phototherapy users and 5.85 among those without a prescription for one of the target therapies. Using a multivariable adjustment approach with time-varying exposure, adjusted HR (95% CI) for biologic users was 4.48 (4.23 to 4.75) compared with oral or phototherapy users. After propensity score matching, the HR (95% CI) was 2.14 (2.00 to 2.28).ConclusionsIn this retrospective cohort study, biologic use was associated with the development of PsA among patients with psoriasis. This may be related to confounding by indication and protopathic bias. Prospective studies are needed to address this important question.

scholarly journals Switching antifibrotics in patients with idiopathic pulmonary fibrosis: a multi-center retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yuzo Suzuki ◽  
Kazutaka Mori ◽  
Yuya Aono ◽  
Masato Kono ◽  
Hirotsugu Hasegawa ◽  
...  
Keyword(s):  
Cohort Study ◽  
Propensity Score ◽  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Disease Progression ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Survival Times ◽  
Antifibrotic Therapy ◽  
Median Period

Abstract Background Currently, there are two antifibrotics used to treat idiopathic pulmonary fibrosis (IPF): pirfenidone and nintedanib. Antifibrotics slow disease progression by reducing the annual decline of forced vital capacity (FVC), which possibly improves outcomes in IPF patients. During treatment, patients occasionally switch antifibrotic treatments. However, prognostic implication of changing antifibrotics has not yet been evaluated. Methods This multi-center retrospective cohort study examined 262 consecutive IPF patients who received antifibrotic therapy. Antifibrotic agents were switched in 37 patients (14.1%). The prognoses were compared between the patient cohort that switched antifibrotics (Switch-IPF) and those without (Non-Switch-IPF) using propensity-score matched analyses. Results The median period between the initiation of antifibrotic therapy and the drug switch was 25.8 (12.7–35.3) months. The most common reasons for the switch were disease progression (n = 17) followed by gastrointestinal disorders (n = 12). Of the 37 patients that switched antifibrotics, only eight patients disrupted switched antifibrotics by their adverse reactions. The overall prognosis of the Switch-IPF cohort was significantly better than the Non-Switch-IPF cohort (median periods: 67.2 vs. 27.1 months, p < 0.0001). In propensity-score matched analyses that were adjusted to age, sex, FVC (%), history of acute exacerbation, and usage of long-term oxygen therapy, the Switch-IPF cohort had significantly longer survival times than the Non-Switch-IPF group (median 67.2 vs. 41.3 months, p = 0.0219). The second-line antifibrotic therapy showed similar survival probabilities than those in first-line antifibrotic therapy in multistate model analyses. Conclusion Switching antifibrotics is feasible and may improve prognosis in patients with IPF. A further prospective study will be required to confirm clinical implication of switching the antifibrotics.

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