Management and outcome of spinal implant-associated surgical site infections in patients with posterior instrumentation: analysis of 176 cases

被引:9
作者
Hickmann, Anne-Katrin [1 ,2 ]
Bratelj, Denis [1 ]
Pirvu, Tatiana [1 ]
Loibl, Markus [1 ]
Mannion, Anne F. [3 ]
O'Riordan, Dave [3 ]
Fekete, Tamas [1 ]
Jeszenszky, Deszo [1 ]
Eberhard, Nadia [4 ]
Vogt, Marku [5 ]
Achermann, Yvonne [4 ]
Haschtmann, Daniel [1 ]
机构
[1] Schulthess Klin, Dept Spine & Neurosurg, Zurich, Switzerland
[2] Kantonsspital St Gallen, Dept Neurosurg, Rorschacher Str 95, CH-9000 St Gallen, Switzerland
[3] Schulthess Klin, Spine Ctr Div, Dept Teaching Res & Dev, Zurich, Switzerland
[4] Univ Zurich, Dept Infect Dis, Univ Hosp Zurich, Zurich, Switzerland
[5] Kantonsspital Zug, Consulting Clin Infect Dis, Zug, Switzerland
关键词
Surgical site infection; Spine; Fusion surgery; Outcome; Quality of life; DEEP WOUND-INFECTION; CLINICALLY IMPORTANT DIFFERENCE; LUMBAR ARTHRODESIS; FUSION; DISEASE; IMPACT; PAIN; PREDICTORS; DISABILITY; SURGERY;
D O I
10.1007/s00586-021-06978-y
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Purpose The management of implant-associated surgical site infections (SSI) in patients with posterior instrumentation is challenging. Evidence regarding the most appropriate treatment and the need for removal of implants is equivocal. We sought to evaluate the management and outcome of such patients at our institution. Methods We searched our prospectively documented databases for eligible patients with posterior spinal instrumentation, excluding the cervical spine (January 2008-June 2018). Patient files were reviewed, demographic data and treatment details were recorded. Patient-reported outcome (PRO) was assessed with the Core Outcome Measures Index (COMI) preoperatively and postoperatively at 3 and 12 months. Results A total of 170 patients underwent 210 revisions for 176 SSIs. Two-thirds presented within four weeks (105/176, 59.7%, median 22.5d, 7d-11.1y). The most common pathogens were Staphylococcus aureus (n = 79/210, 37.6%) and Staphylococcus epidermidis (n = 56/210, 26.7%). Debridement and implant retention was performed in 135/210 (64.3%) revisions and partial replacement in 62/210 (29.5%). In 28/176 SSI (15.9%), persistent infection required multiple revisions (<= 4). Surgery was followed by intravenous and oral antimicrobial treatment (10-12w). In 139/176 SSIs (79%) with >= 1y follow-up, infection was cured in 115/139 (82.7%); relapse occurred in 9 (relapse rate: 5.1%). Two patients (1.4%) died. COMI decreased significantly (8.2 +/- 1.5 vs. 4.8 +/- 2.9, p < 0.0001) over 12 months. 72.7% of patients were (very) satisfied with their care. Conclusion Patients with SSI after posterior (thoraco-)lumbo(-sacral) instrumentation can be successfully treated in most cases with surgical and specific antibiotic treatment. An interdisciplinary approach is recommended. Loose implants should be replaced. In some cases, multiple revisions may be necessary. Patient outcomes were satisfactory.
引用
收藏
页码:489 / 499
页数:11
相关论文
共 29 条
[1]   Preservation of Spinal Instrumentation After Development of Postoperative Bacterial Infections in Patients Undergoing Spinal Arthrodesis [J].
Ahmed, Raheel ;
Greenlee, Jeremy D. W. ;
Traynelis, Vincent C. .
JOURNAL OF SPINAL DISORDERS & TECHNIQUES, 2012, 25 (06) :299-302
[2]   Fate of Hardware in Spinal Infections [J].
Atesok, Kivanc ;
Vaccaro, Alexander ;
Stippler, Martina ;
Striano, Brendan M. ;
Carr, Michael ;
Heffernan, Michael ;
Theiss, Steven ;
Papavassiliou, Efstathios .
SURGICAL INFECTIONS, 2020, 21 (05) :404-410
[3]   Predictors of increased cost and length of stay in the treatment of postoperative spine surgical site infection [J].
Blumberg, Todd J. ;
Woelber, Erik ;
Bellabarba, Carlo ;
Bransford, Richard ;
Spina, Nicholas .
SPINE JOURNAL, 2018, 18 (02) :300-306
[4]   ASSESSMENT OF CHRONIC PAIN .1. ASPECTS OF THE RELIABILITY AND VALIDITY OF THE VISUAL ANALOG SCALE [J].
CARLSSON, AM .
PAIN, 1983, 16 (01) :87-101
[5]   Risk of infection following posterior instrumented lumbar fusion for degenerative spine disease in 817 consecutive cases Clinical article [J].
Chaichana, Kaisorn L. ;
Bydon, Mohamad ;
Santiago-Dieppa, David R. ;
Hwang, Lee ;
McLoughlin, Gregory ;
Sciubba, Daniel M. ;
Wolinsky, Jean-Paul ;
Bydon, Ali ;
Gokaslan, Ziya L. ;
Witham, Timothy .
JOURNAL OF NEUROSURGERY-SPINE, 2014, 20 (01) :45-52
[6]   Postoperative wound infection after posterior spinal instrumentation: analysis of long-term treatment outcomes [J].
Chen, Shih-Hao ;
Lee, Chen-Hsiang ;
Huang, Kuo-Chin ;
Hsieh, Pang-Hsin ;
Tsai, Shan-Yin .
EUROPEAN SPINE JOURNAL, 2015, 24 (03) :561-570
[7]   Surgical site infections following instrumented stabilization of the spine [J].
Dapunt, Ulrike ;
Buerkle, Caroline ;
Guenther, Frank ;
Pepke, Wojciech ;
Hemmer, Stefan ;
Akbar, Michael .
THERAPEUTICS AND CLINICAL RISK MANAGEMENT, 2017, 13 :1239-1245
[8]   Effect of deep wound infection following lumbar arthrodesis for degenerative disc disease on long-term outcome: a prospective study Clinical article [J].
Falavigna, Asdrubal ;
Righesso, Orlando ;
Traynelis, Vincent C. ;
Teles, Alisson Roberto ;
da Silva, Pedro Guarise .
JOURNAL OF NEUROSURGERY-SPINE, 2011, 15 (04) :399-403
[9]   A Randomized, Controlled Trial of Fusion Surgery for Lumbar Spinal Stenosis [J].
Forsth, Peter ;
Olafsson, Gylfi ;
Carlsson, Thomas ;
Frost, Anders ;
Borgstrom, Fredrik ;
Fritzell, Peter ;
Ohagen, Patrik ;
Michaelsson, Karl ;
Sanden, Bengt .
NEW ENGLAND JOURNAL OF MEDICINE, 2016, 374 (15) :1413-1423
[10]   Laminectomy plus Fusion versus Laminectomy Alone for Lumbar Spondylolisthesis [J].
Ghogawala, Zoher ;
Dziura, James ;
Butler, William E. ;
Dai, Feng ;
Terrin, Norma ;
Magge, Subu N. ;
Coumans, Jean-Valery C. E. ;
Harrington, J. Fred ;
Amin-Hanjani, Sepideh ;
Schwartz, J. Sanford ;
Sonntag, Volker K. H. ;
Barker, Fred G., II ;
Benzel, Edward C. .
NEW ENGLAND JOURNAL OF MEDICINE, 2016, 374 (15) :1424-1434