Anne-Katrin Hickmann1,2, Denis Bratelj3, Tatiana Pirvu3, Markus Loibl3, Anne F Mannion4, Dave O'Riordan4, Tamás Fekete3, Deszö Jeszenszky3, Nadia Eberhard5, Marku Vogt6, Yvonne Achermann5, Daniel Haschtmann3. 1. Department of Spine and Neurosurgery, Schulthess Klinik, Zürich, Switzerland. anne-katrin.hickmann@kssg.ch. 2. Department of Neurosurgery, Kantonsspital St. Gallen, Rorschacher Str. 95, 9000, St. Gallen, Switzerland. anne-katrin.hickmann@kssg.ch. 3. Department of Spine and Neurosurgery, Schulthess Klinik, Zürich, Switzerland. 4. Spine Center Division, Department of Teaching, Research and Development, Schulthess Klinik, Zürich, Switzerland. 5. Department of Infectious Diseases, University Hospital Zurich/University Zurich, Zürich, Switzerland. 6. Consulting Clinical Infectious Diseases, Kantonsspital Zug, Zug, Switzerland.
Abstract
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.
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.
Authors: Kaisorn L Chaichana; Mohamad Bydon; David R Santiago-Dieppa; Lee Hwang; Gregory McLoughlin; Daniel M Sciubba; Jean-Paul Wolinsky; Ali Bydon; Ziya L Gokaslan; Timothy Witham Journal: J Neurosurg Spine Date: 2013-11-08
Authors: Samrat Yeramaneni; Jeffrey L Gum; Leah Y Carreon; Eric O Klineberg; Justin S Smith; Amit Jain; Richard A Hostin Journal: J Bone Joint Surg Am Date: 2018-03-21 Impact factor: 5.284