Management of Deep Infection after Instrumentation on Lumbar Spinal Surgery in a Single Institution

Abstract

Postoperative surgical site infections (SSIs) are more common complications after spinal surgery. SSIs often require extended hospitalisation and may worsen overall clinical outcomes. A retrospective database review of consecutive patients with traditional open lumbar spinal surgery was performed. SSIs patients were identified and reviewed for clinically relevant details, and postoperative SSIs' incidence was calculated for the entire cohort as well as for subgroups with or without spinal implants. In 15 years, 1,176 patients underwent open lumbar spinal surgery with spinal implants and 699 without. Thirty-eight developed postoperative SSIs. Total SSI rate for the entire group was 2.03%. The incidence of postoperative SSIs in the nonimplant group was relatively low. Patients received antibiotics, hyperbaric oxygen therapy, and wet dressing. We provided the precise rates of postoperative SSIs in traditional open spinal surgery obtained from a single-centre data. Patients with spinal implants had higher SSIs' incidence than those without.

Deep spinal infection in instrumented spinal surgery: diagnostic factors and therapy

“…Laboratory studies are unreliable indicator of spine infection, high value of ESR remain for up to six weeks after surgery, CRP normalize within two weeks and fever is frequent in the postoperative period (2). However in our series the increase of inflammation indices such as CRP and ESR was statistically significant © C I C E d i z i o n i I n t e r n a z i o n a l i and this is in accord with literature (10)(11)(12)(13)(14)(15). The increase of leucocytes, neutrophils and lymphocytes count was not statistically significant as well as the presence of fever (16).…”

Antimicrobial Prophylaxis in Instrumented Spinal Fusion Surgery: A Comparative Analysis of 24-Hour and 72-Hour Dosages

“…A suitable antibiotic for an appropriate period is mandatory, but prolonged use of prophylactic antibiotics should be avoided [16171819]. There are many articles emphasizing compliance which show that surgical care improvement projects do minimize or influence SSIs [1920]. A retrospective study conducted by Collins et al [12], showed that 1,980 instrumented spinal fusions performed over a period of 10 years had an infection rate of 3.7%.…”

“…S. aureus was the most commonly isolated organism, followed by Propionibacterium . In a recent retrospective analysis by Liu et al [20], 1,176 patients who underwent open, instrumented lumbar fusion were shown to have a deep infection rate of 2.64%, where most commonly isolated organism was S. aureus, followed by MRSA. In a study by Kim et al [21], the efficacy of 48-hour antimicrobial prophylaxis was compared with that of 72-hour dosage, and it was concluded that for clean spinal surgery, antimicrobial prophylaxis for 48 hours is as efficient as that for 72 hours.…”

Postoperative Spinal Implant Infections (PSII)—A Systematic Review: What Do We Know So Far and What is Critical About It?

“…71 While the selection of first line prophylaxis and first line alternative in allergies is relatively consistent among authors, both dosage and time interval of prophylaxis presents itself inconsistently. Some authors suggest a constant amount of prophylaxis (usually 1-2 g cefazolin), 10 while some propose a body weight adapted dosage (e.g., 50 mg/kg). 49 All authors agree that cephalosporin prophylaxis should be started at a maximum of 1 hour prior to incision.…”