Efeito do uso de vancomicina tópica em cirurgia de coluna torácica e lombossacra com instrumentação : potencial em redução de infecção de sítio cirúrgico

Introdução: Infecção de sítio cirúrgico é responsável por elevada morbimortalidade em pacientes submetidos a artrodese de coluna. O uso de antibióticos intravenoso na indução anestésica reduz a taxa de infecção pós-operatória, mas o uso tópico da medicação não é uma conduta sedimentada, a despeito de evidências recentes. Objetivo: Verificar se o uso de Vancomicina tópica reduz a taxa de infecção pós-operatória de sítio cirúrgico em pacientes submetidos a artrodese de coluna toracolombar. Métodos: Ensaio clínico randomizado, duplo-cego e realizado em um único hospital comparando vancomicina tópica e placebo em pacientes submetidos a artrodese de coluna toracolombar. Resultados: Um total de 96 pacientes foram randomizados em grupo placebo ou grupo vancomicina entre agosto de 2014 e abril de 2018. A média de idade foi 43 +- 14,88 anos, 73,95% eram do sexo masculino e a etiologia mais comum foi queda de altura (46,87%). A taxa geral de infecção pós-operatória de sítio cirúrgico foi de 8,33% e não houve diferença entro os grupos, sendo as taxas de infecção pós-operatória no grupo Vancomicina e grupo Placebo de 8,2% e 8,5%; CI 0,28-3,93, p=0,951, respectivamente. Pacientes com Diabetes Mellitus tiveram maior taxa de infecção de sítio cirúrgico [RR=9,98; (1,81-44,61), p=0,007]. Conclusão: Este é o primeiro ensaio clínico randomizado e duplo cego que avaliou o uso de Vancomicina tópica sobre a taxa de infecção pós-operatória em pacientes submetidos à cirurgia de artrodese toracolombar. Mais estudos são necessários para confirmar estes achados.Background: Surgical site infection results in high morbidity and mortality in spinal fusion patients. Using intravenous antibiotics in anesthetic induction reduces the rate of postoperative infection, but it is not common practice to use them topically, despite recent reports that this procedure helps reduce infection. Objective: To determine whether the topical use of vancomycin reduces the rate of postoperative surgical site infection in thoracolumbar fusion patients. Methods: A randomized, double-blind clinical trial in a single hospital comparing vancomycin and placebo in thoracolumbar fusion patients. Results: A total of 96 patients were randomized to placebo or vancomycin treatment. The mean age was 43+- 14.88 years, 73.95% were male and the most common etiology was fall from height (46.87%). The overall rate of postoperative surgical site infection was 8.33%, and no difference was found between the groups: postoperative infection rates in the vancomycin and placebo groups were 8.2% and 8.5% (CI 0.28-3.93, p = 0.951), respectively. Patients with diabetes mellitus had higher surgical site infection rates [RR = 9.98; (1.81-44.61), p = 0.007]. Conclusion: This is the first double-blind randomized clinical trial to evaluate the effects of topical vancomycin on postoperative infection rates in thoracolumbar fusion patients, and the results did not differ significantly from placebo

Brain Abscess Caused by Nocardia: Case Report and Literature Review

Nocardia brain abscess is a rare clinical entity, accounting for 2% of all brain abscesses, associated with high morbidity and a mortality rate 3 times higher than brain abscesses caused by other bacteria. Proper investigation and treatment, characterized by a long-term antibiotic therapy, play an important role on the outcome of the patient. The authors describe a case of a patient without neurological comorbidities who developed clinical signs of right occipital lobe impairment and seizures, whose investigation demonstrated brain abscess caused by Nocardia spp. The patient was treated surgically followed by antibiotic therapy with a great outcome after 1 year of follow-up

THORACOLUMBAR SPINAL ARTHRODESIS - EPIDEMIOLOGY AND COSTS

ABSTRACT Objective: To describe the epidemiology of patients with thoracolumbar spine fracture submitted to surgery at Hospital Cristo Redentor and the related costs. Methods: Prospective epidemiological study between July 2014 and August 2015 of patients with thoracolumbar spine fracture with indication of surgery. The variables analyzed were sex, age, cost of hospitalization, fractured levels, levels of arthrodesis, surgical site infection, UTI or BCP, spinal cord injury, etiology, length of stay, procedure time, and visual analog scale (VAS) . Results: Thirty-two patients were evaluated in the study period, with a mean age of 38.68 years. Male-female ratio was 4:1 and the most frequent causes were fall from height (46.87%) and traffic accidents (46.87%). The thoracolumbar transition was the most affected (40.62%), with L1 vertebra involved in 23.8% of the time. Neurological deficit was present in 40.62% of patients. Hospital stay had a median of 14 days and patients with neurological deficit were hospitalized for a longer period (p<0.001), with an increase in hospital costs (p= 0.015). The average cost of hospitalization was U$2,874.80. The presence of BCP increased the cost of hospitalization, and patients with spinal cord injury had more BCP (p= 0.014) . Conclusion: Public policies with an emphasis on reducing traffic accidents and falls can help reduce the incidence of these injuries and studies focusing on hospital costs and rehabilitation need to be conducted in Brazil to determinate the burden of spinal trauma and spinal cord injury

Traumatic Dissection of Arterial Cervical Vessels: Report of Two Cases and Literature Review

Even though traumatic dissection of cervical arterial vessels is the major cause of stroke among adults, it is still an underdiagnosed disease in neurosurgical emergencies, since most patients do not have or present subtle clinical signs in the acute phase. The authors report two interesting cases of cervical artery dissection with different traumatic mechanisms and present a broad literature review about this subject