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Rocos B, Kato S, Lewis SJ, Shaffrey CI, Lenke LG. Antibiotic Use in Adult Spine Deformity Surgery: Results From the AO Spine Surveillance of the Management of Patients With Adult Spine Deformity. Global Spine J 2023:21925682231201240. [PMID: 37683295 DOI: 10.1177/21925682231201240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/10/2023] Open
Abstract
STUDY DESIGN Cross-sectional international survey with literature review. OBJECTIVES To evaluate the evidence for these strategies and to understand the current trends in prophylactic antibiotic use during ASD surgery through an international survey. METHODS An online survey was conducted among international AO Spine members regarding the peri-operative management of patients with ASD. The details of perioperative systemic and topical antibiotic use were solicited. Descriptive data were summarized for the responding surgeons who perform at least 10 long-segment fusions of >5 levels extending to the pelvis annually. RESULTS The literature supports the use of prophylactic antibiotic effective against gram positive organisms. The use of topical vancomycin remains debated, and there is limited evidence for topical tobramycin use. A total of 116 responses were received. 74 (64%) surgeons use topical vancomycin, most usually deep to the fascia only 45 (61%). The most usual dose used is 1-2 g. 4 (3%) surgeons use topical tobramycin deep to fascia. Following surgery, 90 (78%) surgeons use prophylactic cephalosporin with 3 (3%) using cloxacillin, 5 (4%) using ciprofloxacin and 9 (8%) using vancomycin and 6 (5%) using clindamycin either in addition or alone. CONCLUSIONS The present survey identifies a trend towards systemic and topical antibiotic prophylaxis primarily targeted at gram positive pathogens. The use of topical tobramycin, proposedly effective against gram negative infections, remains uncommon. There is a lack of consensus in the selection of perioperative antibiotic prophylaxis, thus a prospective study of the rates of infection with each strategy would be useful to inform guidelines.
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Affiliation(s)
- Brett Rocos
- Division of Spine Surgery, Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
- AO Knowledge Forum Deformity, Davos, Switzerland
| | - So Kato
- AO Knowledge Forum Deformity, Davos, Switzerland
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Stephen J Lewis
- AO Knowledge Forum Deformity, Davos, Switzerland
- Department of Orthopaedic Surgery, Toronto Western Hospital, Schroeder Arthritis Institute, University of Toronto, Toronto, ON, Canada
| | - Christopher I Shaffrey
- Division of Spine Surgery, Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
- AO Knowledge Forum Deformity, Davos, Switzerland
| | - Lawrence G Lenke
- AO Knowledge Forum Deformity, Davos, Switzerland
- Department of Orthopedic Spine Surgery, The Spine Hospital, Columbia University Medical Center, New York, NY, USA
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Wang Y, Che M, Zheng Z, Liu J, Ji X, Sun Y, Xin J, Gong W, Na S, Jin Y, Wang S, Zhang S. Animal Models for Postoperative Implant‐Related Spinal Infection. Orthop Surg 2022; 14:1049-1058. [PMID: 35466555 PMCID: PMC9163983 DOI: 10.1111/os.13238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 01/13/2022] [Accepted: 01/19/2022] [Indexed: 12/04/2022] Open
Abstract
Postoperative infections following implant‐related spinal surgery are severe and disastrous complications for both orthopaedic surgeons and patients worldwide. They can cause neurological damage, disability, and death. To better understand the mechanism of these destructive complications and intervene in the process, further research is needed. Therefore, there is an urgent need for efficient, accurate, and easily available animal models to study the pathogenesis of spinal infections and develop new and effective anti‐bacterial methods. In this paper, we provide a general review of the commonly used animal models of postoperative implant‐related spinal infections, describe their advantages and disadvantages, and highlight the significance of correctly choosing the model according to the infection aspect under investigation. These models are valuable tools contributing to the better understanding of postoperative spinal infections and will continue to facilitate the invention of novel preventative and treatment strategies for patients with postoperative spinal infections. However, although they are valid and reproducible in some respects, the current animal models present certain limitations. Future ideal spinal infection animal models may assess the bacterial load of the same animal in real‐time in vivo, and better mimic the human anatomy as well as surgical techniques. Strains other than Staphylococcus aureus account for a large proportion of postoperative spinal infections, and thus, the establishment of models to evaluate other types of microbial infections is expected in the future. Furthermore, novel transgenic models established on advancements in genome editing are also likely to be developed in the future.
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Affiliation(s)
- Yongjie Wang
- Department of Spinal Surgery the First Hospital of Jilin University Changchun China
- Jilin Engineering Research Center for Spine and Spinal Cord Injury Changchun China
| | - Mingxue Che
- Department of Spinal Surgery the First Hospital of Jilin University Changchun China
- Jilin Engineering Research Center for Spine and Spinal Cord Injury Changchun China
| | - Zhi Zheng
- Department of Spinal Surgery the First Hospital of Jilin University Changchun China
- Jilin Engineering Research Center for Spine and Spinal Cord Injury Changchun China
| | - Jun Liu
- Institute of Military Veterinary Science the Academy of Military Medical Science of PLA Changchun China
| | - Xue Ji
- Institute of Military Veterinary Science the Academy of Military Medical Science of PLA Changchun China
| | - Yang Sun
- Institute of Military Veterinary Science the Academy of Military Medical Science of PLA Changchun China
| | - Jingguo Xin
- Department of Spinal Surgery the First Hospital of Jilin University Changchun China
- Jilin Engineering Research Center for Spine and Spinal Cord Injury Changchun China
| | - Weiquan Gong
- Department of Spinal Surgery the First Hospital of Jilin University Changchun China
- Jilin Engineering Research Center for Spine and Spinal Cord Injury Changchun China
| | - Shibo Na
- Department of Spinal Surgery the First Hospital of Jilin University Changchun China
- Jilin Engineering Research Center for Spine and Spinal Cord Injury Changchun China
| | - Yuanzhe Jin
- Department of Spinal Surgery the First Hospital of Jilin University Changchun China
- Jilin Engineering Research Center for Spine and Spinal Cord Injury Changchun China
| | - Shuo Wang
- Department of Ophthalmology the Second Hospital of Jilin University Changchun China
| | - Shaokun Zhang
- Department of Spinal Surgery the First Hospital of Jilin University Changchun China
- Jilin Engineering Research Center for Spine and Spinal Cord Injury Changchun China
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Joyce K, Sakai D, Pandit A. Preclinical models of vertebral osteomyelitis and associated infections: Current models and recommendations for study design. JOR Spine 2021; 4:e1142. [PMID: 34337331 PMCID: PMC8313152 DOI: 10.1002/jsp2.1142] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 01/22/2021] [Accepted: 01/27/2021] [Indexed: 12/17/2022] Open
Abstract
Spine-related infections, such as vertebral osteomyelitis, discitis, or spondylitis, are rare diseases that mostly affect adults, and are usually of hematogenous origin. The incidence of this condition has gradually risen in recent years because of increases in spine-related surgery and hospital-acquired infections, an aging population, and intravenous (IV) drug use. Spine infections are most commonly caused by Staphylococcus aureus, while other systemic infections such as tuberculosis and brucellosis can also cause spondylitis. Various animal models of vertebral osteomyelitis and associated infections have been investigated in mouse, rat, chicken, rabbit, dog, and sheep models by hematogenous and direct inoculation in surgery, each with their strengths and limitations. This review is the first of its kind to concisely analyze the various existing animal models used to reproduce clinically relevant models of infection. Spine-related infection models must address the unique anatomy of the spine, the avascular nature of its structures and tissues and the consequences of tissue destruction such as spinal cord compression. Further investigation is necessary to elucidate the specific mechanisms of host-microbe response to inform antimicrobial therapy and administration techniques in a technically demanding body cavity. Small-animal models are not suitable for large instrumentation, and difficult IV access thwarts antibiotic administration. In contrast, large-animal models can be implanted with clinically relevant instrumentation and are resilient to repeat procedures to study postoperative infection. A canine model of infection offers a unique opportunity to design and investigate antimicrobial treatments through recruitment a rich population of canine patients, presenting with a natural disease that is suitable for randomized trials.
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Affiliation(s)
- Kieran Joyce
- CÚRAM SFI Research Centre for Medical DevicesNational University of IrelandGalwayIreland
- School of MedicineNational University of IrelandGalwayIreland
| | - Daisuke Sakai
- Department of Orthopaedic SurgeryTokai University School of MedicineIseharaJapan
| | - Abhay Pandit
- CÚRAM SFI Research Centre for Medical DevicesNational University of IrelandGalwayIreland
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Intraoperative Tobramycin Powder Prevents Enterobacter cloacae Surgical Site Infections in a Rabbit Model of Internal Fixation. J Orthop Trauma 2021; 35:35-40. [PMID: 32516196 DOI: 10.1097/bot.0000000000001859] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/01/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To evaluate the efficacy of intraoperative tobramycin powder in preventing surgical site infection (SSI) and implant colonization with Enterobacter cloacae in a rabbit fixation model. Gram-negative rods, particularly Enterobacter species, comprise an increasing percentage of SSI at our institution. METHODS Eighteen New Zealand White rabbits underwent surgical fixation of the left tibia with implantation of a plate and screws. The surgical site and implant were inoculated with 1 × 107 CFUs E. cloacae. The selected E. cloacae isolate was resistant to tobramycin and capable of forming biofilms. Nine rabbits received 125 mg tobramycin powder directly into the surgical site, overlying the implant. The control group was untreated. Fourteen days postinfection, the tibiae and implants were explanted. Radiographs were taken with and without the implants in place. One tibia from each group was examined after hematoxylin and eosin staining. The remaining tibiae and implants were morselized or sonicated, respectively, and plated on agar to determine infection burden. Data were analyzed with Fisher exact tests and Mann-Whitney U tests. RESULTS No bone infection or implant colonization occurred in the tobramycin-treated group. In the control group, 7 of 8 rabbits developed bone infections (P = 0.001), and 4 of 8 implants were colonized (P = 0.07). No gross disruption of the normal bone architecture was observed in either group. CONCLUSIONS Intraoperative tobramycin powder applied at the time of contamination prevented bone infection with E. cloacae in this rabbit fixation model. The results are encouraging because the E. cloacae isolate was tobramycin-resistant, demonstrating the utility of intraoperative powdered antibiotics.
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Highly efficient imidazolium-containing oligomers for preventing MRSA biofilm and postoperative spinal infection. Eur Polym J 2020. [DOI: 10.1016/j.eurpolymj.2020.109910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Gordon O, Miller RJ, Thompson JM, Ordonez AA, Klunk MH, Dikeman DA, Joyce DP, Ruiz-Bedoya CA, Miller LS, Jain SK. Rabbit model of Staphylococcus aureus implant-associated spinal infection. Dis Model Mech 2020; 13:dmm.045385. [PMID: 32586832 PMCID: PMC7406311 DOI: 10.1242/dmm.045385] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/16/2020] [Indexed: 12/22/2022] Open
Abstract
Post-surgical implant-associated spinal infection is a devastating complication commonly caused by Staphylococcus aureus. Biofilm formation is thought to reduce penetration of antibiotics and immune cells, contributing to chronic and difficult-to-treat infections. A rabbit model of a posterior-approach spinal surgery was created, in which bilateral titanium pedicle screws were interconnected by a plate at the level of lumbar vertebra L6 and inoculated with a methicillin-resistant S.aureus (MRSA) bioluminescent strain. In vivo whole-animal bioluminescence imaging (BLI) and ex vivo bacterial cultures demonstrated a peak in bacterial burden by day 14, when wound dehiscence occurred. Structures suggestive of biofilm, visualized by scanning electron microscopy, were evident up to 56 days following infection. Infection-induced inflammation and bone remodeling were also monitored using 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) and computed tomography (CT). PET imaging signals were noted in the soft tissue and bone surrounding the implanted materials. CT imaging demonstrated marked bone remodeling and a decrease in dense bone at the infection sites. This rabbit model of implant-associated spinal infection provides a valuable preclinical in vivo approach to investigate the pathogenesis of implant-associated spinal infections and to evaluate novel therapeutics. Summary: A model of post-surgical methicillin-resistant Staphylococcus aureus implant-associated spinal infection was created in rabbits, recapitulating acute infection as well as chronic low-burden infection, with structures suggestive of biofilm formation and bone remodeling.
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Affiliation(s)
- Oren Gordon
- Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.,Center for Infection and Inflammation Imaging Research, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Robert J Miller
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - John M Thompson
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Alvaro A Ordonez
- Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.,Center for Infection and Inflammation Imaging Research, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Mariah H Klunk
- Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.,Center for Infection and Inflammation Imaging Research, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Dustin A Dikeman
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Daniel P Joyce
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Camilo A Ruiz-Bedoya
- Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.,Center for Infection and Inflammation Imaging Research, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Lloyd S Miller
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.,Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.,Immunology, Janssen Research and Development, Spring House, PA 19477, USA
| | - Sanjay K Jain
- Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA .,Center for Infection and Inflammation Imaging Research, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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Abstract
In July of 2018, the Second International Consensus Meeting (ICM) on Musculoskeletal Infection convened in Philadelphia, PA was held to discuss issues regarding infection in orthopedic patients and to provide consensus recommendations on these issues to practicing orthopedic surgeons. During this meeting, attending delegates divided into subspecialty groups to discuss topics specifics to their respective fields, which included the spine. At the spine subspecialty group meeting, delegates discussed and voted upon the recommendations for 63 questions regarding the prevention, diagnosis, and treatment of infection in spinal surgery. Of the 63 questions, 9 focused on implants questions in spine surgery, for which this article provides the recommendations, voting results, and rationales.
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Spinal Fusion Surgery and Local Antibiotic Administration: A Systematic Review on Key Points From Preclinical and Clinical Data. Spine (Phila Pa 1976) 2020; 45:339-348. [PMID: 31568186 DOI: 10.1097/brs.0000000000003255] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Systematic review. OBJECTIVE The present review of clinical and preclinical in vivo studies focused on the local antibiotic administration for surgical site infection (SSI) in spinal fusion procedures and identifying new approaches or research direction able to release antibiotics in the infected environment. SUMMARY OF BACKGROUND DATA SSI is a severe complication of spinal fusion procedures that represents a challenging issue for orthopedic surgeons. SSIs can range from 0.7% to 2.3% without instrumentation up to 6.7% with the use of instrumentation with significant implications in health care costs and patient management. METHOD A systematic search was carried out by two independent researchers according to the PRISMA statement in three databases (www.pubmed.com, www.scopus.com and www.webofknowledge.com) to identify preclinical in vivo and clinical reports in the last 10 years. Additionally, to evaluate ongoing clinical trials, three of the major clinical registry websites were also checked (www.clinicaltrials.gov, www.who.int/ictrp, https://www.clinicaltrialsregister.eu). RESULTS After screening, a total of 43 articles were considered eligible for the review: 36 clinical studies and seven preclinical studies. In addition, six clinical trials were selected from the clinical registry websites. CONCLUSION The results reported that the topical vancomycin application seem to represent a strategy to reduce SSI incidence in spine surgery. However, the use of local vancomycin as a preventive approach for SSIs in spine surgery is mostly based on retrospective studies with low levels of evidence and moderate/severe risk of bias that do not allow to draw a clear conclusion. This review also underlines that several key points concerning the local use of antibiotics in spinal fusion still remains to be defined to allow this field to make a leap forward that would lead to the identification of specific approaches to counteract the onset of SSIs. LEVEL OF EVIDENCE 4.
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Ishida W, Perdomo-Pantoja A, Elder BD, Locke J, Holmes C, Witham TF, Lo SFL. Effects of Intraoperative Intrawound Antibiotic Administration on Spinal Fusion: A Comparison of Vancomycin and Tobramycin in a Rat Model. J Bone Joint Surg Am 2019; 101:1741-1749. [PMID: 31577679 DOI: 10.2106/jbjs.18.00988] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Local, intrawound use of antibiotic powder, such as vancomycin and tobramycin, in spinal fusion surgery has become an increasingly common prophylactic measure in an attempt to reduce rates of postsurgical infection. However, the effects of localized antibiotic delivery on fusion remain unclear. The objective of this study was to examine the in vivo effects of intraoperative local delivery of 2 antibiotics commonly used in bone-grafting surgery on spinal fusion outcomes in a rat model. METHODS Single-level (L4-L5), bilateral posterolateral intertransverse process lumbar fusion surgery was performed on 60 female Lewis rats (6 to 8 weeks of age) using syngeneic iliac crest allograft mixed with clinical bone-graft substitute and varying concentrations of antibiotics (n = 12 each): (1) control without any antibiotics, (2) low-dose vancomycin (14.3 mg/kg), (3) high-dose vancomycin (71.5 mg/kg), (4) low-dose tobramycin (28.6 mg/kg), and (5) high-dose tobramycin (143 mg/kg). Eight weeks postoperatively, fusion was evaluated via micro-computed tomography (µCT), manual palpation, and histological analysis, with blinding to treatment group. In the µCT analysis, fusion-mass volumes were measured for each rat. Each spine specimen (L4-L5) was rated (manual palpation score) on a scale of 2 to 0 (2 = fused, 1 = partially fused, and 0 = non-fused). RESULTS The mean fusion-mass volume on µCT (mm) was as follows: control, 29.3 ± 6.2; low-dose vancomycin, 26.3 ± 8.9; high-dose vancomycin, 18.8 ± 7.9; low-dose tobramycin, 32.7 ± 9.0; and high-dose tobramycin, 43.8 ± 11.9 (control versus high-dose vancomycin, p < 0.05; and control versus high-dose tobramycin, p < 0.05). The mean manual palpation score for each group was as follows: control, 1.46 ± 0.58; low-dose vancomycin, 0.86 ± 0.87; high-dose vancomycin, 0.68 ± 0.62; low-dose tobramycin, 1.25 ± 0.71; and high-dose tobramycin, 1.32 ± 0.72 (control versus high-dose vancomycin, p < 0.05). The histological analyses demonstrated a similar trend with regard to spinal fusion volume. CONCLUSIONS Intraoperative local application of vancomycin, particularly at a supraphysiological dosage, may have detrimental effects on fusion-mass formation. No inhibitory effect of tobramycin on fusion-mass formation was observed. CLINICAL RELEVANCE When spine surgeons decide to use intraoperative intrawound antibiotics in spinal fusion surgery, they should weigh the reduction in surgical site infection against a possible inhibitory effect on fusion.
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Affiliation(s)
- Wataru Ishida
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | - John Locke
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christina Holmes
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Timothy F Witham
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sheng-Fu L Lo
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Shillingford JN, Laratta JL, Reddy H, Ha A, Lehman RA, Lenke LG, Fischer CR. Postoperative Surgical Site Infection After Spine Surgery: An Update From the Scoliosis Research Society (SRS) Morbidity and Mortality Database. Spine Deform 2019; 6:634-643. [PMID: 30348337 DOI: 10.1016/j.jspd.2018.04.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 03/11/2018] [Accepted: 04/09/2018] [Indexed: 11/30/2022]
Abstract
STUDY DESIGN Retrospective review of prospectively collected data. OBJECTIVE Analyze the Scoliosis Research Society (SRS) Morbidity & Mortality (M&M) database to assess the incidence and characteristics related to postoperative surgical site infection (SSI) after spinal deformity surgery. SUMMARY OF BACKGROUND DATA Infections involving spinal instrumentation are associated with greater rates of disability. Rates of postoperative SSI after spinal deformity surgery range from 1.9% to 4.4%. Postoperative SSI rates of 4.2% for adult kyphosis, 2.1% for adult spondylolisthesis, and 3.7% for adult scoliosis have been reported. METHODS The SRS M&M database was evaluated to define patient demographics, perioperative factors, and infection characteristics of spinal deformity patients with postoperative spine infections after deformity surgery in 2012. RESULTS Of the 47,755 procedures reported to the SRS in 2012, there were 578 (1.2%) diagnosed SSIs. Infection rates for patients with kyphosis were significantly higher compared with patients with scoliosis (2.4% vs. 1.1%, p < .0001) or spondylolisthesis (2.4% vs. 1.1%, p < .0001). Spinal fusions were performed in 86.3% of patients, 75.1% of which were performed posteriorly. Osteotomies were performed in 30.1% of patients. Deep infections below the fascia accounted for 68.0% of infections. Methicillin-sensitive (41.9%) and methicillin-resistant (17.0%) Staphylococcus aureus were the most commonly isolated pathogens, whereas gram-negative bacteria accounted for 25.4% of cases. Long-term antibiotic suppression was required in 18.9% of patients, and overall complications from antibiotics occurred in 4.5% of patients. Operative treatment was required in 81.8% of SSI cases. CONCLUSION SSIs occur in 1.2% of spine deformity patients, with a rate significantly higher in patients with kyphosis. Approximately 25% of these infections are secondary to gram-negative species. Antibiotic complications occur in 4.5% of patients being treated for SSI. Despite advancements in surgical technique and infection prophylaxis, postoperative SSI remains one of the most common complications in spinal deformity surgery. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Jamal N Shillingford
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital, New York-Presbyterian Healthcare System, 5141 Broadway, 3 Field West, New York, NY 10034, USA
| | - Joseph L Laratta
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital, New York-Presbyterian Healthcare System, 5141 Broadway, 3 Field West, New York, NY 10034, USA.
| | - Hemant Reddy
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital, New York-Presbyterian Healthcare System, 5141 Broadway, 3 Field West, New York, NY 10034, USA
| | - Alex Ha
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital, New York-Presbyterian Healthcare System, 5141 Broadway, 3 Field West, New York, NY 10034, USA
| | - Ronald A Lehman
- The Daniel and Jane Och Spine Hospital, NewYork-Presbyterian/The Allen Hospital, 5141 Broadway, 3 Field West, New York, NY 10034, USA
| | - Lawrence G Lenke
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital, New York-Presbyterian Healthcare System, 5141 Broadway, 3 Field West, New York, NY 10034, USA
| | - Charla R Fischer
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital, New York-Presbyterian Healthcare System, 5141 Broadway, 3 Field West, New York, NY 10034, USA
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