Jang W Yoon1, Nathan R Wanderman2, Panagiotis Kerezoudis3, Mohammed Ali Alvi3, Gaetano De Biase4, Oluwaseun O Akinduro4, Elie F Berbari5, Mohamad Bydon6, Brett A Freedman2. 1. Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA. 2. Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA. 3. Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA. 4. Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA. 5. Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA. 6. Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA. Electronic address: bydon.mohamad@mayo.edu.
Abstract
BACKGROUND: Gram-negative surgical site infections (SSI) following spine surgery are becoming increasingly more common owing to a broad perioperative antibiotic usage targeting gram-positive organisms. Enterobacter species have been reported to be the most common gram-negative bacteria following spine surgery. METHODS: We queried our institutional database for Enterobacter SSIs after spine surgery at a single institution from 2009-2016. Relevant demographic, clinical, and operative variables were collected. We compared this cohort to patients who had non-Enterobacter SSI during the same period. RESULTS: Enterobacter species were isolated in 16 patients (9 males) diagnosed with SSI after undergoing spine surgery. This group represented 0.2% of all spine cases and 14.5% of all spinal SSIs. Seven patients (43.8%) required multiple irrigations and debridements (I&Ds) (range: 2-8), whereas only 17 of 94 patients (18.1%) with non-Enterobacter SSI required multiple I&Ds (range: 2-5, P = 0.043). Those infected with Enterobacter were associated with higher BMI (37.6 ± 12.7 vs. 31.7 ± 8, P = 0.036), earlier wound dehiscence (14.8 vs. 24.6 days, P = 0.01), polymicrobial infections (37.5% vs. 10.6%, P = 0.012), and longer length of stay (18 days [9.5-31.5] vs. 5 days [3-8], P = 0.01) when compared to non-Enterobacter SSI cohort. At an average of 24.2 months follow-up, all 15 surviving patients were infection free with no further revision surgeries needed. CONCLUSIONS: Enterobacter SSI cases were associated with higher BMI, earlier wound breakdown, polymicrobial infection and longer length of stay. Nevertheless, with vigilant surveillance and timely I&Ds, these challenging infections can be treated successfully with original implant retention in almost all cases.
BACKGROUND: Gram-negative surgical site infections (SSI) following spine surgery are becoming increasingly more common owing to a broad perioperative antibiotic usage targeting gram-positive organisms. Enterobacter species have been reported to be the most common gram-negative bacteria following spine surgery. METHODS: We queried our institutional database for Enterobacter SSIs after spine surgery at a single institution from 2009-2016. Relevant demographic, clinical, and operative variables were collected. We compared this cohort to patients who had non-Enterobacter SSI during the same period. RESULTS: Enterobacter species were isolated in 16 patients (9 males) diagnosed with SSI after undergoing spine surgery. This group represented 0.2% of all spine cases and 14.5% of all spinal SSIs. Seven patients (43.8%) required multiple irrigations and debridements (I&Ds) (range: 2-8), whereas only 17 of 94 patients (18.1%) with non-Enterobacter SSI required multiple I&Ds (range: 2-5, P = 0.043). Those infected with Enterobacter were associated with higher BMI (37.6 ± 12.7 vs. 31.7 ± 8, P = 0.036), earlier wound dehiscence (14.8 vs. 24.6 days, P = 0.01), polymicrobial infections (37.5% vs. 10.6%, P = 0.012), and longer length of stay (18 days [9.5-31.5] vs. 5 days [3-8], P = 0.01) when compared to non-Enterobacter SSI cohort. At an average of 24.2 months follow-up, all 15 surviving patients were infection free with no further revision surgeries needed. CONCLUSIONS: Enterobacter SSI cases were associated with higher BMI, earlier wound breakdown, polymicrobial infection and longer length of stay. Nevertheless, with vigilant surveillance and timely I&Ds, these challenging infections can be treated successfully with original implant retention in almost all cases.
Authors: Gaetano De Biase; William D Freeman; Mohamad Bydon; Nathan Smith; Daniel Jerreld; Jorge Pascual; John Casler; Chris Hasse; Alfredo Quiñones-Hinojosa; Kingsley Abode-Iyamah Journal: Mayo Clin Proc Innov Qual Outcomes Date: 2020-12-10