Is Propionibacterium acnes becoming the most common bacteria in delayed infections following adolescent idiopathic scoliosis surgery?

Kardile, Mayur; Bains, Sukhraj S; Kuo, Calvin C.; Lincoln, Todd L.; Bains, Ravi S.

doi:10.1007/s43390-020-00250-x

Cited by 4 publications

(4 citation statements)

References 45 publications

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“…A multicenter, retrospective study of surgical site infection among pediatric patients following scoliosis surgery found that patients with neuromuscular scoliosis had the highest infection rate (9.2%), followed by those with syndromic scoliosis (8.8%), other scoliosis types (8.4%), congenital scoliosis (3.9%), and idiopathic scoliosis (2.6%) ( 44 ). Cutibacterium acnes is a pathogen frequently found in infections following scoliosis surgery, especially in delayed infections ( 51 - 53 ). Cluster 3 was associated with risk factors and prevention of IASIS.…”

Section: Discussionmentioning

confidence: 99%

Global research characteristics and trends of infection after spinal implant surgery: a bibliometric analysis

Li¹,

Wu²,

Sun³

et al. 2023

Ann Transl Med

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Background: With the growing awareness of postoperative infection, increasing focus has been placed on infection after spinal implant surgery (IASIS). This study aimed to explore the development and trends of research regarding IASIS using bibliometric analysis. Methods: Scientific articles on IASIS research published between February 1, 2000, and December 31, 2020 were retrieved from the Web of Science database. Results: A total of 820 publications were included in the bibliometric analysis, with studies originating from 46 countries and 6 languages. Researchers from the United States published the highest number of articles and collaborated closely with researchers in Canada, Germany, and Japan. The author with the most publications was Alexander R. Vaccaro. The journal with the most articles and citations was Spine. Most of the research was performed on risk factors and the incidence of IASIS. Co-occurrence analysis revealed that the most recent research trend was likely related to the management of IASIS and the international consensus meeting. Three clusters of research were identified through a thematic map: diagnosis and treatment of IASIS, scoliosis-related infection, and risk factors and prevention of IASIS. Conclusions: Research on IASIS increasingly grew between 2000 and 2020. Spinal surgeons and institutes from the United States had the highest number of publications and academic impact in this field. Diagnosisrelated problems and multidisciplinary work on IASIS require further attention in the future. Current trends in IASIS are likely associated with IASIS management and the international consensus meeting.

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Section: Discussionmentioning

confidence: 99%

Global research characteristics and trends of infection after spinal implant surgery: a bibliometric analysis

Li¹,

Wu²,

Sun³

et al. 2023

Ann Transl Med

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“…have some specific features suggests that tailored preventive measures for this population should likely be implemented. In adolescent patients operated on for idiopathic scoliosis, some authors have proposed different strategies such as the local administration of vancomycin powder before wound closure or treating patients with C. acnes lesions with tetracycline 2 weeks before surgery and during the first postoperative week [ 23 ]. Other authors have suggested switching antibiotic prophylaxis from cefazoline to cefamandole in the adolescent population [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Cutibacterium spp. Infections after Instrumented Spine Surgery Have a Good Prognosis Regardless of Rifampin Use: A Cross-Sectional Study

et al. 2023

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Infection after spinal instrumentation (IASI) by Cutibacterium spp is being more frequently reported. The aim of this study was to analyse the incidence, risk factors, clinical characteristics, and outcome of a Cutibacterium spp. IASI (CG) compared with non-Cutibacterium IASI (NCG) infections, with an additional focus on the role of rifampin in the treatment. All patients from a multicentre, retrospective, observational study with a confirmed IASI between January 2010 and December 2016 were divided into two groups: (CG and NCG) IASI. Baseline, medical, surgical, infection treatment, and follow-up data were compared for both groups. In total, 411 patients were included: 27 CG and 384 NCG. The CG patients were significantly younger. They had a longer median time to diagnosis (23 vs. 13 days) (p = 0.025), although 55.6% debuted within the first month after surgery. Cutibacterium patients were more likely to have the implant removed (29.6% vs. 12.8%; p = 0.014) and received shorter antibiotic regimens (p = 0.014). In 33% of Cutibacterium cases, rifampin was added to the baseline therapy. None of the 27 infections resulted in treatment failure during follow-up regardless of rifampin use. Cutibacterium spp. is associated with a younger age and may cause both early and late IASIs. In our experience, the use of rifampin to improve the outcome in the treatment of a Cutibacterium spp. IASI is not relevant since, in our series, none of the cases had therapeutic failure regardless of the use of rifampin.

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“…C. acnes has long been recognized as a frequent pathogen in shoulder joint surgical infections, and recent studies have implicated its role in pediatric and adolescent spinal fusion SSIs. 14,17 In recent studies by Kardile et al and Swarup et al, 18,19 the majority of acute C. acnes infections were successfully treated with debridement and implant retention, while delayed infection was associated with a higher incidence of pseudoarthrosis, and necessitated hardware removal in all cases.…”

Section: Discussionmentioning

confidence: 99%

Implant-associated Infection After Pediatric Spine Deformity Surgery: Is Removal of Hardware Indicated?

Wei,

Brown,

Moore

et al. 2023

Pediatric Infectious Disease Journal

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Background: Postoperative spinal implant infection following pediatric spinal surgery often presents a management dilemma. We aimed to characterize our experience in this cohort of patients, hoping to provide further insight when approaching these challenging cases. Methods: A retrospective, observational study was performed of all children who underwent spinal surgery from January 2015 to June 2021 in a tertiary pediatric spinal surgery referral center in Queensland, Australia. Records were reviewed to identify cases of postoperative surgical site infection, with particular focus on children with infection directly involving implants. Preoperative prophylaxis, microbiology, clinical course and outcomes were analyzed. Results: A total of 580 children underwent 933 procedures during the study period. The most common pathology requiring surgery was idiopathic scoliosis in 257 children (44.3%) followed by neuromuscular scoliosis in 192 children (33.1%). There were 35 cases of surgical site infection (6.03%), and 9 were implant-associated (1.55%). Infection rate among children with neuromuscular spinal deformity was almost 3-fold higher (11.5%) than idiopathic (3.89%). Methicillin-sensitive Staphylococcus aureus was the most commonly isolated organism (n = 15). Four implant-associated infections were successfully managed with retention of implant; all were diagnosed within 32 days (median = 20 days) and cultured either Staphylococcus aureus or Pseudomonas aeruginosa. Conversely, infections that necessitated implant removal had a more indolent onset (median = 175 days), and more often cultured Cutibacterium acnes and coagulase-negative Staphylococci. Conclusions: Postoperative spinal implant infection can be treated successfully with hardware retention in select cases. Earlier presentation and recognition appear to be associated with better rates of retention and are linked to certain organisms. Further exploration of specific preventative strategies may be key in preventing devastating late-onset infections.

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Is Propionibacterium acnes becoming the most common bacteria in delayed infections following adolescent idiopathic scoliosis surgery?

Cited by 4 publications

References 45 publications

Global research characteristics and trends of infection after spinal implant surgery: a bibliometric analysis

Global research characteristics and trends of infection after spinal implant surgery: a bibliometric analysis

Cutibacterium spp. Infections after Instrumented Spine Surgery Have a Good Prognosis Regardless of Rifampin Use: A Cross-Sectional Study

Implant-associated Infection After Pediatric Spine Deformity Surgery: Is Removal of Hardware Indicated?

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