Use of PET/CT in the early diagnosis of implant related wound infection and avoidance of wound debridement

Wang, Yue; Cheung, Jason Pui-Yin; Cheung, Kenneth M.C.

doi:10.1007/s00586-015-4044-5

Cited by 11 publications

(10 citation statements)

References 22 publications

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“…147 When compared to leukocyte scans, PET is considerably quicker, typically requiring only 2-3 h. There is lower radiation exposure and reduced costs. 148,149 Most importantly, information gathered from PET/CT scans is three-dimensional. The anatomical location of infection is accurately defined.…”

Section: Positron Emission Tomographymentioning

confidence: 99%

“…152 In very early stages of infection, surgical debridement may be totally avoided by early initiation of antibiotics. 149 Currently, the optimal diagnostic criteria of OAI in PET remain to be studied and accurately defined. False positive exams can rarely occur from acute fracture healing and early post-operative inflammation especially within the first 6 weeks after osteosynthesis.…”

Section: Diagnosismentioning

confidence: 99%

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Infection after fracture osteosynthesis – Part I

Fang

Wong

Lau

et al. 2017

J Orthop Surg (Hong Kong)

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Bone and surgical site infections after osteosynthesis are notoriously difficult to manage and pose a tremendous burden in fracture management. In this article, we use the term osteosynthesis-associated infection (OAI) to refer to this clinical entity. While relatively few surgically treated fractures become infected, it is challenging to perform a rapid diagnosis. Optimal management strategies are complex and highly customized to each scenario and take into consideration the status of fracture union, the presence of hardware and the degree of mechanical stability. At present, a high level of relevant evidence is unavailable; most findings presented in the literature are based on laboratory work and non-randomized clinical studies. We present this overview of OAI in two parts: an examination of recent literature concerning OAI pathogenesis, diagnosis and classification and a review of treatment options.

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Section: Positron Emission Tomographymentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

Infection after fracture osteosynthesis – Part I

Fang

Wong

Lau

et al. 2017

J Orthop Surg (Hong Kong)

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“…However, not all patients can afford additional assessments (e.g. CT, MRI, PET) because these methods are very expensive and requires a lot of time [13][14][15] . Therefore, postoperative laboratory markers are often used to screen SSI due to their objectivity, low cost and convenience 12,16 .…”

Section: Discussionmentioning

confidence: 99%

Usefulness of Lymphocyte ratio and CRP Level for Early Detection of Surgical Site Infection Following spinal surgery

Wei¹,

Dang²,

Duan³

et al. 2019

Preprint

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Background: To investigate the significant laboratory markers for early diagnosis of surgical site infection after spinal surgery. And determine the diagnostic cut-off values of these markers Methods: A total of 67 patients participated in the study: 11 patients who developed surgical site infection after spinal surgery (SSI Group) and 56 patients were compared with the infected group in terms of age，gender, operating time and intraoperative blood loss (Non-SSI Group). The white blood cell (WBC) count , WBC differential , C-reactive protein (CRP) and erythrocyte sedimentation rate(ESR) were determined before and 1, 3 and 7 days postoperatively . Then, we determine the diagnostic cutoff for these markers by using the receiver operating characteristic curve. Results: The CRP, ESR and WBC were significantly higher in the SSI group at 3 and 7 days postoperatively. The lymphocyte ratio at 3 days postoperatively was significantly lower in the SSI Group. Using the receiver operating characteristic curve，lymphocyte ratio <11.5% at 3 days postoperatively (sensitivity 90.9%, specificity 75.4%, area under the curve [AUC] 0.919), and C-reactive protein level >26 mg/dL at 7 days postoperatively (sensitivity 90.9%, specificity 87.7%, area under the curve [AUC] 0.954) were the significant laboratory marker for early detection of SSI Conclusion: Lymphocyte ratio<11.5% at 3 days and C-reactive protein levels>26.5mg/dl at 7 days after spinal surgery are reliable markers of SSI.

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“…Distribution by ASA preoperative anesthetic risk was as follows, 24.7% of the patients were ASA I, 46% ASA II, 27.6% ASA III, and 1.7% ASA IV. The median BMI was 27.7 (range: 11.11-45.47); 32% of the patients were overweight (BMI [25][26][27][28][29][30] and 64 patients (36.7%) were obese (BMI .30). The mean modified frailty index (mFI) 8 was 0.08 (range: 0.00-0.45).…”

Section: Statistical Methods and Levels Of Significancementioning

confidence: 99%

“…It is likely that positron emission tomography and computed tomography with fluorodeoxyglucose F-18 could be of more value than bone scintigraphy for the instrumented spinal surgery infection diagnosis and selective treatment. 26 We applied the Zimmerli and Ochsner 9 classification for early, delayed, late infections because of its recognition in prosthetic surgery. In spinal fusion surgery, after 2 years following surgery, usually a solid fusion mass is achieved.…”

Section: No Of Cases Of Each Complication Treatmentmentioning

confidence: 99%

Deep Surgical-Site Infection Following Thoracolumbar Instrumented Spinal Surgery: The Experience of 25 Years

et al. 2021

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Background: Deep surgical-site infection following thoracolumbar instrumented spinal surgery (DSITIS) is a major complication in spine surgery and its impact on long-term morbidity and mortality is yet to be determined. This article describes the characteristics and evolution of DSITIS in our center over a period of 25 years. Methods: This single-center, retrospective cohort study included patients diagnosed with DSITIS between January 1992 and December 2016 and with a minimum follow-up after infection diagnosis of 1 year. The Infectious Diseases Society of America criteria and/or Centers for Disease Control and Prevention criteria were used to define DSITIS. Patient data (epidemiological and health status), surgical data, infection characteristics and presentation, isolated microorganisms, required surgical debridements, implant removal, and major complications linked to infection were evaluated. Results: A total of 174 patients (106 females) were included in the analysis. Mean follow-up after infection diagnosis was 40 months (56 patients with over 5 years follow-up). Adolescent idiopathic scoliosis, adult deformity, and degenerative lumbar stenosis were the most frequent etiologies for primary surgery. Presentation of infection was considered early (0-3 months since first surgery) in 59.2% of the cases, delayed (3-24 months) in 11.5%, and late (more than 24 months) in 29.3%. All patients were treated by surgical debridement. More than 1 surgical debridement was necessary in 20.7% of cases. Implants were removed in 46.6% of the patients (72.83% in the first surgical debridement). Most frequently isolated microorganisms were Staphylococcus spp, Enterobacteriaceae, and Cutibacterium acnes. Major complications appeared in 14.3% of the patients, and over 80% of them required major surgeries to resolve those complications. Conclusions: Late DSITIS is more frequent than previously reported. In DSITIS culprits, Staphylococcus spp, Enterobacteriaceae, and Cutibacterium acnes predominate. DSITIS produce a high rate of major complications that usually require major surgery for treatment. Level of Evidence: 3.

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Use of PET/CT in the early diagnosis of implant related wound infection and avoidance of wound debridement

Cited by 11 publications

References 22 publications

Infection after fracture osteosynthesis – Part I

Infection after fracture osteosynthesis – Part I

Usefulness of Lymphocyte ratio and CRP Level for Early Detection of Surgical Site Infection Following spinal surgery

Deep Surgical-Site Infection Following Thoracolumbar Instrumented Spinal Surgery: The Experience of 25 Years

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