Postoperative Spinal Implant Infections in Children

Lamberet, Aurore; Violas, Philippe; Buffet-Bataillon, Sylvie; Hamel, Antoine; Launay, Élise; Lamberet, R.; Arvieux, Cédric; Tattevin, Pierre

doi:10.1097/inf.0000000000001812

Cited by 17 publications

(19 citation statements)

References 10 publications

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“…49 All authors agree that cephalosporin prophylaxis should be started at a maximum of 1 hour prior to incision. 10,29,39,49,50,61,65 A repeated prophylaxis was performed by Collins et al when surgery was more than 2 hours, 31 by Liu, Lamberet and Litrico et al in operations longer than 4 hours, 10,49,72 by Fang et al after 6 hours of surgery or significant blood loss, 13 and by Pull ter Gunne et al after 4 hours or 1.5-liter blood loss. 29,61 In contrast, some authors suggest a prolonged antibiotic prophylaxis not only in selected cases but rather as a postoperative standard in all cases, independently of surgery time or 70 and Chang et al for up to 5 days.…”

Section: Results Of Individual Studiesmentioning

confidence: 97%

“…Debridement and implant retention with antibiotics (DAIR) is a possible treatment strategy for acute infections. 47 - 49 Thereby, a second look surgery might improve the therapeutic outcome in DAIR. 50 In this context, the role of DAIR in chronic cases unable to undergo implant removal / exchange due to instability or perioperative factors remains unknown.…”

Section: Resultsmentioning

confidence: 99%

“… 66 - 69 All authors cited in this systematic review, except Tofuku et al 65 (proposing a synthetic penicillin), used a first- (cefazolin, cephalothin) or second-generation (cefuroxime, cefamandole, cefonicid) cephalosporin as first line preoperative antibiotic prophylaxis. 10 , 15 , 22 , 26 , 27 , 29 , 39 , 49 , 50 , 54 , 61 Some authors additionally used a second combined preoperative antibiotic prophylaxis such as an aminoglycoside in selected cases. 22 , 70 , 71 In cases of known allergy to penicillin or cephalosporin, vancomycin was used/suggested by all authors, 10 , 15 , 29 , 50 , 61 , 72 except Bosch-Nicolau et al that suggested a combination of clindamycin and gentamycin in known beta-lactam allergy instead.…”

Section: Resultsmentioning

confidence: 99%

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

Karczewski

Schnake

Osterhoff

et al. 2021

Global Spine Journal

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Study Design: Systematic review. Objectives: Postoperative spinal implant infections (PSII) are an increasing challenge in the daily clinical routine. This review summarizes existing knowledge in the field of PSII, including definitions, epidemiology, classifications, risk factors, pathogenesis, symptoms, diagnosis, and treatment. Methods: A systematic review was performed using a structured PubMed analysis, based on the PRISMA criteria. The search terminology was set as: “spinal implant associated infection OR spinal implant infection OR spinal instrumentation infection OR peri spinal implant infection.” PubMed search was limited to the categories randomized controlled trials (RCT), clinical trials, meta-analysis and (systematic) reviews, whereas case reports were excluded. Studies from January 2000 to December 2020 were considered eligible. A total of 572 studies were identified, 82 references included for qualitative synthesis, and 19 for detailed sub analysis (12 meta-analysis, 7 prospective RCT). Results: Structural problems in the field of PSII were revealed, including (1) limited level of evidence in clinical studies (missing prospective RCT, metanalyzes), (2) small patient numbers, (3) missing standardized definitions, (4) heterogeneity in patient groups, and (5) redundancy in cited literature. Conclusion: Evidence-based knowledge about spinal implant-associated infections is lacking. All involved medical fields should come together to define the term PSII and to combine their approaches toward research, training, and patient care.

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Section: Results Of Individual Studiesmentioning

confidence: 97%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

Karczewski

Schnake

Osterhoff

et al. 2021

Global Spine Journal

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“…In der Behandlung von PSII wird bei Frühinfektionen von den meisten Autoren eine "Debridement and Implant Retention with Antibiotics" (DAIR) Strategie empfohlen [18,41,42,43,44]. Demgegenüber ist bei Spätinfektionen mit Biofilm-bildenden Erregern eine Retention der Implantate in der Regel nicht möglich und sollte nicht versucht werden [18,42,45,46].…”

Section: Operative Behandlungskonzepteunclassified

Implantatversagen aufgrund von Infekt/Low-grade Infekt – Ursachen und Behandlungskonzepte

Ringel

Jägersberg

2022

Die Wirbelsäule

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ZusammenfassungImplantatversagen im Sinne von Implantatlockerungen sind eine regelmäßige Komplikation spinaler Instrumentierungen. Die Ursachen von Implantatlockerungen sind oft aseptisch. Allerdings zeigen eine Reihe jüngerer Studien, dass Infektionen, insbesondere „low-grade“ Infektionen für einen relevanten Anteil der Implantatlockerungen ursächlich sind. Diese Infekt-bedingten Implantatlockerungen bedürfen einer angepassten Strategie im Hinblick auf Diagnostik und Therapie. Zur sicheren Diagnostik Infekt-bedingter Lockerungen sind Sonikate der Implantate notwendig. Die Implantatentfernung oder ein -tausch bei Lockerung sollte von einer angepassten Antibiotikatherapie begleitet sein.

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“…MSSA were pvl-suggesting no relevance of this toxin in implant-associated infections. MSSA is a major cause of S. aureus IAIs in both adult and pediatric patients [26,27].…”

Section: Plos Onementioning

confidence: 99%

Adhesin genes and biofilm formation among pediatric Staphylococcus aureus isolates from implant-associated infections

et al. 2020

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Background Microbial surface component recognizing adhesive matrix molecules (MSCRAMMs) facilitate Staphylococcus aureus adherence to host tissue. We hypothesized that S. aureus isolates from implant-associated infections (IAIs) would differ in MSCRAMM profile and biofilm formation in vitro compared to skin and soft tissue infection (SSTI) isolates. Methods Pediatric patients and their isolates were identified retrospectively. IAI and SSTI isolates were matched (1:4). Pulsed field gel electrophoresis was performed to group isolates as USA300 vs. non-USA300. Whole genome sequencing was performed and raw sequence data were interrogated for presence of MSCRAMMs (clfA, clfB, cna, ebh, efb, fnbpA, fnbpB, isdA, isdB, sdrC, sdrD, sdrE), biofilm-associated (icaA,D,B,C), and Panton-Valentine leukocidin (lukSF-PV) genes, accessory gene regulator group, and multilocus sequence types. In vitro biofilm formation was assessed for 47 IAI and 47 SSTI isolates using a microtiter plate assay. Conditional logistic regression was performed for analysis of matched data (STATA11, College Station, TX). Results Forty-seven IAI and 188 SSTI isolates were studied. IAI isolates were more often methicillin susceptible S. aureus and non-USA300 vs. SSTI isolates [34 (72%) vs. 79 (42%), p = 0.001 and 38 (81%) vs. 57 (30%) p <0.001, respectively]. Greater than 98% of isolates carried clfA, clfB, efb, isdA, isdB, and icaA,D,B,C while cna was more frequently found among IAI vs. SSTI isolates (p = 0.003). Most isolates were strong biofilm producers.

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Postoperative Spinal Implant Infections in Children

Abstract: Postoperative spinal implant infection is not rare in pediatric patients, especially with neurologic scoliosis. Most children may be cured with implant retention if managed with early surgery followed by a 3-month course of appropriate antibacterial agents.

Cited by 17 publications

References 10 publications

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

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

Implantatversagen aufgrund von Infekt/Low-grade Infekt – Ursachen und Behandlungskonzepte

Adhesin genes and biofilm formation among pediatric Staphylococcus aureus isolates from implant-associated infections

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