Surgical Site Infections in Spine Surgery

Abdul-Jabbar, Amir; Berven, Sigurd; Hu, Serena S.; Chou, Dean; Mummaneni, Praveen V.; Takemoto, Steven K.; Ames, Christopher P.; Deviren, Vedat; Tay, Bobby; Weinstein, P R; Burch, Shane; Liu, Catherine

doi:10.1097/brs.0b013e3182a42a68

Cited by 136 publications

(51 citation statements)

References 25 publications

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“…A study from the USA evaluating a total of 532 694 surgical procedures showed a prevalence of 0.7 infections per 100 procedures, 10-fold lower than that of LATAM in the current evaluation (Baker et al, 2016). Past estimates from the USA have indicated that as many as 3.2% of patients experienced an SSI after spinal surgery (Abdul-Jabbar et al, 2013). However, more recent reports have indicated a reduced incidence of SSI in spinal fusion surgeries (1.2%) (Baker et al, 2016), as well as orthopedic procedures like hip arthroplasty (1.5%) and knee arthroplasty (0.9%), likely due to institutional infection control measures and the use of vancomycin powder during surgery (Gaviola et al, 2016;Khan et al, 2014;Caroom et al, 2013).…”

Section: Discussionmentioning

confidence: 52%

Surgical site infection in elective clean and clean-contaminated surgeries in developing countries

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Cané

Fernández³

et al. 2019

International Journal of Infectious Diseases

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Background: Surgical site infection (SSI) is both the most frequently studied healthcare-associated infection and the most common healthcare-associated infection in the developing world. A systematic review and meta-analysis was conducted to evaluate the relative size of this burden and to estimate the prevalence of SSI in clean and clean-contaminated surgeries in a large sample of countries in the developing world. Methods: A systematic search of the MEDLINE/PubMed, Scopus, and LILACS databases was conducted to identify studies providing the prevalence of SSI in elective clean and clean-contaminated surgeries in 39 countries or regions around the world. Data of interest were limited to publications from January 2000 to December 2017. Studies with information on the number of cases of SSI and number of total elective clean and clean-contaminated surgeries during the same period were included in this evaluation. Studies lacking clear definition of the total number of exposed patients were excluded. Results: Based on the combined data from the 99 articles evaluated in this analysis, the overall prevalence of SSI in elective clean and clean-contaminated surgeries was estimated to be 6% (95% confidence interval (CI) 5-7%). This increased to 15% (95% CI 6-27%) when considering only those reports with post-discharge surveillance data. The overall prevalence of SSI in Africa/Middle East, Latin America, Asia, and China was 10% (95% CI 6-15%), 7% (95% CI 5-10%), 4% (95% CI 4-5%), and 4% (95% CI 2-6%), respectively. Significant variability in the data was confirmed by both the funnel plot and the Egger test (p = 0.008). Conclusions: Although the data are variable, it is clear that the incidence of SSI in the developing world is higher than that in the developed world.

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Section: Discussionmentioning

confidence: 52%

Surgical site infection in elective clean and clean-contaminated surgeries in developing countries

Curcio

Cané

Fernández³

et al. 2019

International Journal of Infectious Diseases

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“…Early SSIs, potentially predominant reason for early reoperations following spinal surgery, occur at an average time of 3 weeks after the index procedure. [6,7] We believe that early SSIs should be included in the causes of ''early reoperations,'' and we therefore defined 30 days as the period of interest in this study. On the other hand, in the United States, 30-day readmission is considered one of the problems of the health care system [8][9][10], and hospitals with a high 30-day unplanned readmission rate may be financially penalized in the near future [11].…”

Section: Introductionmentioning

confidence: 99%

A multi-center study of reoperations within 30 days of spine surgery

et al. 2015

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“… 1 , 2 , 4 , 5 An increase in the proportion of SSI following arthroplasty and spine fusion caused by GNB has been recently reported nationwide. 4 , 6 – 8 Also, an increased resistance of GNB to cefazolin has been observed. 6 – 8 Accordingly, current clinical practice guidelines for antimicrobial prophylaxis in surgery recommend using active surveillance and local resistance patterns when selecting agents for perioperative prophylaxis.…”

Section: Introductionmentioning

confidence: 96%

“… 4 , 6 – 8 Also, an increased resistance of GNB to cefazolin has been observed. 6 – 8 Accordingly, current clinical practice guidelines for antimicrobial prophylaxis in surgery recommend using active surveillance and local resistance patterns when selecting agents for perioperative prophylaxis. 4 …”

Section: Introductionmentioning

confidence: 96%

Single high dose gentamicin for perioperative prophylaxis in orthopedic surgery: Evaluation of nephrotoxicity

et al. 2015

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Background:Recent studies described an increase in acute kidney injury when high dose gentamicin was included in perioperative prophylaxis for orthopedic surgeries. To this effect, we compared the rate of nephrotoxicity for selected orthopedic surgeries where gentamicin was included (Gentamicin Group) to those where it was not included (Control Group) for perioperative prophylaxis and evaluated risk factors for nephrotoxicity.Methods:Spine, hip and knee surgeries performed between April 2011 and December 2013 were reviewed retrospectively. Gentamicin was given to eligible patients based on age, weight and Creatinine Clearance. Nephrotoxicity was assessed using Risk, Injury, Failure, Loss, End-stage kidney disease (RIFLE) criteria.Results:Among selected surgeries (N = 1590 in Gentamicin Group: hip = 926, spine = 600, knee = 64; N = 2587 in Control Group: hip = 980, spine = 902, knee = 705), patients’ body weight, serum creatinine, comorbidities and surgery duration were similar in Gentamicin Group and Control Group. Gentamicin median dose was 4.5 mg/kg of dosing weight. Nephrotoxicity rate was 2.5% in Gentamicin Group and 1.8% in Control Group, p = 0.17. Most cases of nephrotoxicity were Risk category by RIFLE criteria (67% in Gentamicin Group and 72% in Control Group, p = 0.49). In logistic regression, risk factors for nephrotoxicity were hospital stay >1 day prior to surgery (odds ratio = 8.1; 95% confidence interval = 2.25–28.97, p = 0.001), knee or hip surgery (odds ratio = 4.7; 95% confidence interval = 2.9–9.48, p = 0.0005) and diabetes (odds ratio = 1.95; 95% confidence interval = 1.13–3.35, p = 0.016). Receipt of gentamicin was not an independent predictor of nephrotoxicity (odds ratio = 1.5; 95% confidence interval = 0.97–2.35, p = 0.07).Conclusion:In this cohort, rate of nephrotoxicity was similar between Gentamicin Group and Control Group. Single high dose gentamicin is a safe and acceptable option for perioperative prophylaxis in eligible patients undergoing orthopedic surgeries.

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Surgical Site Infections in Spine Surgery

Abstract: 3.

Cited by 136 publications

References 25 publications

Surgical site infection in elective clean and clean-contaminated surgeries in developing countries

Surgical site infection in elective clean and clean-contaminated surgeries in developing countries

A multi-center study of reoperations within 30 days of spine surgery

Single high dose gentamicin for perioperative prophylaxis in orthopedic surgery: Evaluation of nephrotoxicity

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