1
|
Rico Nieto A, Loeches Yagüe B, Quiles Melero I, Talavera Buedo G, Pizones J, Fernández-Baillo Sacristana N. [Translated article] Descriptive study of spinal instrumentation-related infections in a tertiary hospital. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:T201-T208. [PMID: 38232934 DOI: 10.1016/j.recot.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 08/11/2023] [Indexed: 01/19/2024] Open
Abstract
INTRODUCTION Spinal instrumentation-related infections (SIRI) are one of the main causes of post-surgical complication and comorbidity. Our objective was to describe the clinical and microbiological characteristics, treatment and prognosis of these infections. MATERIAL AND METHODS We conducted a retrospective study in our institution (2011-2018) including adult patients undergoing spinal instrumentation who met the diagnostic criteria for confirmed infection. Superficial surgical wound and deep intraoperative samples were processed for microbiological culture. The medical and orthopaedic team was always the same. RESULTS Forty-one cases were diagnosed of which 39 patients (95.1%) presented early infection (<3 months after initial surgery) with symptoms in the first two weeks, mean CRP at diagnosis was 133mg/dl and 23% associated bacteremia. The remaining two patients (4.8%) were chronic infections (symptoms >3 months after surgery). The treatment of choice in early infections was the Debridement, Antibiotics and Implant Retention (DAIR) strategy without removal of the bone graft, which successfully resolved 84.2% of the infections. The main aetiology was gram-positive (Staphylococcus aureus: 31.7%), followed by gram-negative and polymicrobial flora. Antibiotics were optimised according to cultures with a mean duration of 12 weeks. CONCLUSIONS In early infections, early diagnosis and DAIR strategy (with bone graft retention) demonstrated a healing rate higher than 80%.
Collapse
Affiliation(s)
- A Rico Nieto
- Unidad de Infecciosas y Microbiología Clínica, Hospital Universitario La Paz, Madrid, Spain.
| | - B Loeches Yagüe
- Unidad de Infecciosas y Microbiología Clínica, Hospital Universitario La Paz, Madrid, Spain
| | - I Quiles Melero
- Servicio de Microbiología y Parasitología, Hospital Universitario La Paz, Madrid, Spain
| | - G Talavera Buedo
- Unidad de Raquis, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario La Paz, Madrid, Spain
| | - J Pizones
- Unidad de Raquis, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario La Paz, Madrid, Spain
| | | |
Collapse
|
2
|
Rico Nieto A, Loeches Yagüe B, Quiles Melero I, Talavera Buedo G, Pizones J, Fernández-Baillo Sacristana N. Descriptive study of spinal instrumentation-related infections in a tertiary hospital. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:201-208. [PMID: 37690513 DOI: 10.1016/j.recot.2023.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/21/2023] [Accepted: 08/11/2023] [Indexed: 09/12/2023] Open
Abstract
INTRODUCTION Spinal instrumentation-related infections (SIRI) are one of the main causes of post-surgical complication and comorbidity. Our objective was to describe the clinical and microbiological characteristics, treatment and prognosis of these infections. MATERIAL AND METHODS We conducted a retrospective study in our institution (2011-2018) including adult patients undergoing spinal instrumentation who met the diagnostic criteria for confirmed infection. Superficial surgical wound and deep intraoperative samples were processed for microbiological culture. The medical and orthopaedic team was always the same. RESULTS Forty-one cases were diagnosed of which 39 patients (95.1%) presented early infection (<3 months after initial surgery) with symptoms in the first two weeks, mean CRP at diagnosis was 133mg/dl and 23% associated bacteremia. The remaining two patients (4.8%) were chronic infections (symptoms >3 months after surgery). The treatment of choice in early infections was the Debridement, Antibiotics and Implant Retention (DAIR) strategy without removal of the bone graft, which successfully resolved 84.2% of the infections. The main etiology was gram-positive (Staphylococcus aureus: 31.7%), followed by gram-negative and polymicrobial flora. Antibiotics were optimized according to cultures with a mean duration of 12 weeks. CONCLUSIONS In early infections, early diagnosis and DAIR strategy (with bone graft retention) demonstrated a healing rate higher than 80%.
Collapse
Affiliation(s)
- A Rico Nieto
- Unidad de Infecciosas y Microbiología Clínica, Hospital Universitario La Paz, Madrid, España.
| | - B Loeches Yagüe
- Unidad de Infecciosas y Microbiología Clínica, Hospital Universitario La Paz, Madrid, España
| | - I Quiles Melero
- Servicio de Microbiología y Parasitología, Hospital Universitario La Paz, Madrid, España
| | - G Talavera Buedo
- Unidad de Raquis, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario La Paz, Madrid, España
| | - J Pizones
- Unidad de Raquis, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario La Paz, Madrid, España
| | | |
Collapse
|
3
|
San-Juan R, Paredes I, Ramírez-Nava E, Delgado-Fernández J, Panero I, Hernández-Ortiz P, Ramírez-Vicente E, Fernández-Ruiz M, López-Medrano F, Corbella L, Rodríguez-Goncer I, Brañas P, Lagares A, Aguado JM. Reduction of Instrumentation-Related Spine Surgical Site Infections After Optimization of Surgical Techniques. A Single Center Retrospective Analysis. Global Spine J 2024; 14:438-446. [PMID: 35712900 PMCID: PMC10802549 DOI: 10.1177/21925682221109557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE Although surgical risk factors for developing spine surgical site infections (S-SSI) have been identified, the impact of such knowledge in its prevention has not been demonstrated. METHODS We evaluated in 500 patients undergoing spine surgery between 2011 and 2019 at Hospital 12 de Octubre the changes in S-SSI rates over time. Surgical variables independently related to S-SSI were analyzed by univariate and multivariate analysis using binary logistic regression models. A case-control sub-analysis (1:4), matched by the surgical variables identified in the overall cohort was also performed. RESULTS Twenty cases of S-SSI were identified (4%), with a significant decrease in the incidence rate across consecutive time periods (6.6% [2011-2014] vs .86% [2015-2019]; P-value <.0001)). Multivariate analysis identified arthrodesis involving sacral levels (odds ratio [OR]: 2.57; 95% confidence interval [95%CI]: 1.02-6.47; P-value = .044) and instrumentation over 4-8 vertebrae (OR: 2.82; 95%CI: 1.1-7.1; P-value = .027) as independent risk factors for S-SSI. The reduction in the incidence of S-SSI concurred temporally with a reduction in instrumentations involving 4-8 vertebrae (55% vs 21.8%; P-value <.0001) and sacral vertebrae (46.9% vs 24.6%; P-value <.0001) across both periods. The case-control analysis matched by these surgical variables failed to identify other factors independently related to the occurrence of S-SSI. CONCLUSIONS Spinal fusion of more than 4 levels and the inclusion of sacral levels were independently related to the risk of S-SSI. Optimization of surgical techniques by reducing these two types of instrumentation could significantly reduce S-SSI rates.
Collapse
Affiliation(s)
- Rafael San-Juan
- Unit of Infectious Diseases, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Complutense University of Madrid, Madrid, Spain
| | - Igor Paredes
- Department of Neurosurgery, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Complutense University of Madrid, Madrid, Spain
| | - Esther Ramírez-Nava
- Unit of Infectious Diseases, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Complutense University of Madrid, Madrid, Spain
| | - Juan Delgado-Fernández
- Department of Neurosurgery, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Complutense University of Madrid, Madrid, Spain
| | - Irene Panero
- Department of Neurosurgery, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Complutense University of Madrid, Madrid, Spain
| | - Paula Hernández-Ortiz
- Unit of Infectious Diseases, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Complutense University of Madrid, Madrid, Spain
| | - Elia Ramírez-Vicente
- Unit of Infectious Diseases, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Complutense University of Madrid, Madrid, Spain
| | - Mario Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Complutense University of Madrid, Madrid, Spain
| | - Francisco López-Medrano
- Unit of Infectious Diseases, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Complutense University of Madrid, Madrid, Spain
| | - Laura Corbella
- Unit of Infectious Diseases, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Complutense University of Madrid, Madrid, Spain
| | - Isabel Rodríguez-Goncer
- Unit of Infectious Diseases, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Complutense University of Madrid, Madrid, Spain
| | - Patricia Brañas
- Department of Microbiology, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Hospital Universitario “12 de Octubre”, Madrid, Spain
| | - Alfonso Lagares
- Department of Neurosurgery, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Complutense University of Madrid, Madrid, Spain
| | - José María Aguado
- Unit of Infectious Diseases, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Complutense University of Madrid, Madrid, Spain
| |
Collapse
|
4
|
Vierra M, Rouhani Ravari M, Soleymani Sardoo F, Shogan BD. Tailored Pre-Operative Antibiotic Prophylaxis to Prevent Post-Operative Surgical Site Infections in General Surgery. Antibiotics (Basel) 2024; 13:99. [PMID: 38275328 PMCID: PMC10812803 DOI: 10.3390/antibiotics13010099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 01/27/2024] Open
Abstract
The average American today undergoes three inpatient and two outpatient surgical procedures during one's life, each of which carries with it a risk of post-operative infection. It has long been known that post-operative infections cause significant morbidity in the immediate peri-operative period, but recent evidence suggests that they can have long-term consequences as well, increasing a patient's risk of infectious complications in unrelated surgeries performed months or even years later. While there are several theories on the origin of this association, including bacterial colonization of a post-operative infectious wound site, antimicrobial resistance from curative courses of antibiotics, subclinical immunosuppression, or the creation of an inflammatory "pathobiome" following an infectious insult, it is ultimately still unclear why patients who experience a single post-operative infection seem to be at a significantly higher risk of experiencing subsequent ones. Regardless, this association has significant implications for the routine use of pre-operative antibiotic prophylaxis. Indeed, while the prescription of antibiotics pre-operatively has dramatically reduced the rate of post-operative infections, the chosen prophylaxis regimens are typically standardized according to national guidelines, are facing increasing antimicrobial resistance patterns, and have been unable to reduce the risk of post-operative infection to acceptably low levels for certain surgeries. As a result, some clinicians have speculated that tailoring pre-operative antibiotic prophylaxis according to a patient's prior infectious and operative history could improve efficacy and further reduce the rate of post-operative infections. The purpose of this review is to describe the evidence for the link between multiple post-operative infections and explore the efficacy of individualized pre-operative prophylaxis.
Collapse
Affiliation(s)
- Mason Vierra
- Pritzker School of Medicine, The University of Chicago, Chicago, IL 60637, USA;
| | - Mohsen Rouhani Ravari
- Department of Surgery, The University of Chicago Medicine, Chicago, IL 60637, USA; (M.R.R.); (F.S.S.)
| | - Fatemeh Soleymani Sardoo
- Department of Surgery, The University of Chicago Medicine, Chicago, IL 60637, USA; (M.R.R.); (F.S.S.)
| | - Benjamin D. Shogan
- Department of Surgery, The University of Chicago Medicine, Chicago, IL 60637, USA; (M.R.R.); (F.S.S.)
| |
Collapse
|
5
|
Haskell-Mendoza AP, Radhakrishnan S, Nardin AL, Eilbacher K, Yang LZ, Jackson JD, Lee HJ, Sampson JH, Fecci PE. Utility of Routine Preoperative Urinalysis in the Prevention of Surgical Site Infections. World Neurosurg 2023; 180:e449-e459. [PMID: 37769846 DOI: 10.1016/j.wneu.2023.09.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/17/2023] [Accepted: 09/20/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE Preoperative assessment is important for neurosurgical risk stratification, but the level of evidence for individual screening tests is low. In preoperative urinalysis (UA), testing may significantly increase costs and lead to inappropriate antibiotic treatment. We prospectively evaluated whether eliminating preoperative UA was noninferior to routine preoperative UA as measured by 30-day readmission for surgical site infection in adult elective neurosurgical procedures. METHODS A single-institution prospective, pragmatic study of patients receiving elective neurosurgical procedures from 2018 to 2020 was conducted. Patients were allocated based on same-day versus preoperative admission status. Rates of preoperative UA and subsequent wound infection were measured along with detailed demographic, surgical, and laboratory data. RESULTS The study included 879 patients. The most common types of surgery were cranial (54.7%), spine (17.4%), and stereotactic/functional (19.5%). No preoperative UA was performed in 315 patients, while 564 underwent UA. Of tested patients, 103 (18.3%) met criteria for suspected urinary tract infection, and 69 (12.2%) received subsequent antibiotic treatment. There were 14 patients readmitted within 30 days (7 without UA [2.2%] vs. 7 with UA [1.2%]) for subsequent wound infection with a risk difference of 0.98% (95% confidence interval -0.89% to 2.85%). The upper limit of the confidence interval exceeded the preselected noninferiority margin of 1%. CONCLUSIONS In this prospective study of preoperative UA for elective neurosurgical procedures using a pragmatic, real-world design, risk of readmission due to surgical site infection was very low across the study cohort, suggesting a limited role of preoperative UA for elective neurosurgical procedures.
Collapse
Affiliation(s)
| | - Senthil Radhakrishnan
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Ana Lisa Nardin
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Kristina Eilbacher
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Lexie Zidanyue Yang
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Joshua D Jackson
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Hui-Jie Lee
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - John H Sampson
- Department of Neurosurgery, Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Peter E Fecci
- Department of Neurosurgery, Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, North Carolina, USA.
| |
Collapse
|
6
|
Nagaoki T, Kumagai G, Wada K, Tanaka S, Asari T, Ishibashi Y. Association between Preoperative Urine Culture and Urinary Tract Infection after Spinal Surgery. Asian Spine J 2023; 17:176-184. [PMID: 35989508 PMCID: PMC9977977 DOI: 10.31616/asj.2021.0533] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 05/04/2022] [Indexed: 11/23/2022] Open
Abstract
STUDY DESIGN This is a retrospective study. PURPOSE This study assessed risk factors accounting for urinary tract infections (UTIs) to determine whether preoperative asymptomatic UTI (aUTI) could be used to predict UTIs in patients after spinal surgery. OVERVIEW OF LITERATURE UTI is a spinal surgery complication that increases the incidence of surgical site infections. However, the risk factors for UTIs after spinal surgery remain unclear. METHODS This study included 509 (mean age, 54.5 years; 239 males and 270 females) patients who underwent posterior spine surgery at the department of the current study. First, clean catch urine was collected, after which a urine culture was performed for all patients before surgery. Preoperative detection of the aUTI (>105 colony-forming units/mL) rate was then determined. Subsequently, risk factors for postoperative UTI were evaluated using logistic regression analysis with the following as independent variables: age, sex, obesity, diabetes, spinal cord tumor, the preoperative Japanese Orthopedic Association (JOA) score, JOA-bladder function, preoperative urine culture positivity, aUTI, preoperative Escherichia coli detection, the postoperative catheter placement period, instrumentation, number of surgical levels, surgery duration, and blood loss. RESULTS The preoperative aUTI and postoperative UTI incidences were 8.1% and 4.1%, respectively. Furthermore, multivariate logistic analysis showed that the risk factor for postoperative UTI was preoperative aUTI (odds ratio, 4.234; 95% confidence interval, 1.532-11.702; p=0.005). CONCLUSIONS Preoperative aUTI is a risk factor for UTI in patients after spinal surgery.
Collapse
Affiliation(s)
- Toshihide Nagaoki
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Gentaro Kumagai
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kanichiro Wada
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Sunao Tanaka
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Toru Asari
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| |
Collapse
|
7
|
Kumagai G, Wada K, Asari T, Nitobe Y, Ishibashi Y. Association of Methicillin-Resistant Coagulase-Negative Staphylococci on Preoperative Skin and Surgical Site Infection in Patients Undergoing Spinal Surgery: A Retrospective Cohort Study. Spine Surg Relat Res 2022; 6:596-603. [PMID: 36561166 PMCID: PMC9747210 DOI: 10.22603/ssrr.2021-0263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/03/2022] [Indexed: 12/25/2022] Open
Abstract
Introduction The aim of this study was to investigate the association of methicillin-resistant coagulase-negative staphylococci (MRCNS) on preoperative skin and surgical site infections (SSIs) in patients undergoing spinal surgery. Methods A total of 507 cases (239 males and 268 females; mean age: 56.1 years) were included in this retrospective study, using prospectively collected data. All patients underwent skin culturing of the surgical site preoperatively. To identify independent risk factors for SSIs as the dependent variable, sequential multivariate logistic regression analyses were conducted. Age, sex, body mass index, presence of rheumatoid arthritis (RA), steroid uses, the American Society of Anesthesiologists Physical Status (ASA-PS) ≥3, MRCNS-positivity on skin bacterial culture, instrumentation, and Japanese Orthopedic Association (JOA) score were used as independent variables. Results Preoperatively, MRCNS was detected from skin culture in 50 (9.9%) cases. The frequency of RA, steroid uses, and ASA-PS ≥3 was significantly higher in MRCNS-positive cases than in MRCNS-negative cases. There were 21 (4.1%) post-spinal surgery SSI cases. Multivariate logistic regression analyses revealed that JOA scores (odds ratio (OR), 0.864; 95% confidence interval (CI), 0.764-0.977) and MRCNS-positivity (OR, 5.060; 95% CI, 1.787-14.323) were significantly associated with SSIs. Conclusions Preoperatively, the incidence of MRCNS was 9.9%; it was the most common cause of postoperative SSIs. MRCNS-positivity was the most associated factor for SSIs.
Collapse
Affiliation(s)
- Gentaro Kumagai
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kanichiro Wada
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Toru Asari
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yoshiro Nitobe
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| |
Collapse
|
8
|
Choi JHK, Duong HA, Williams S, Lee J, Oh M, Rosen C, Lee YP, Bhatia N. The efficacy of bactrim in reducing surgical site infections after spine surgery. NORTH AMERICAN SPINE SOCIETY JOURNAL 2022; 9:100095. [PMID: 35141659 PMCID: PMC8820075 DOI: 10.1016/j.xnsj.2021.100095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/29/2021] [Accepted: 11/29/2021] [Indexed: 10/26/2022]
Abstract
BACKGROUND Previous studies show an increasing incidence of gram-negative organisms in surgical site infections after spine surgery. This study is looking for the association of the post-operative prophylactic use of Bactrim and the gram-negative surgical site infection after lumbar spine surgery. METHODS Patients who underwent lumbar spine surgery between August 2010 and December 2019 at the institution were retrospectively reviewed. RESULTS There were 11 infections out of 511 cases where no oral antibiotics were given (2.2%). There were 2 infections out of 84 cases where Bactrim was given (2.4%). This was not statistically significant (P=0.89). The organisms cultured from the no oral antibiotic group were 8 cases of methicillin sensitive Staphylococcus aureus (MSSA), 1 case of E. coli, 1 case of Pseudomonas aeruginosa, 1 case of MRSA. The organisms cultured from the Bactrim group were 1 case of MRSA, and 1 case of combined Citrobacter freundii and methicillin sensitive Staphylococcus aureus (MSSA). CONCLUSION There was no statistically significant difference in SSIs when Bactrim was given for two weeks after surgery. However, two subjects who developed infection from the Bactrim group were paradoxically affected by gram-negative and antibiotic resistant organisms. So, clinicians should be judicious in their use of oral antibiotics after spine surgery. Level of Evidence: III.
Collapse
Affiliation(s)
- Jeffrey Hyun-Kyu Choi
- Department of Orthopaedic Surgery, University of California, Irvine, CA, United States
| | - Huy Alex Duong
- Department of Orthopaedic Surgery, University of California, Irvine, CA, United States
| | - Sean Williams
- Department of Orthopaedic Surgery, University of California, Irvine, CA, United States
| | - Joshua Lee
- Department of Orthopaedic Surgery, University of California, Irvine, CA, United States
| | - Michael Oh
- Department of Neurosurgery, University of California, Irvine, CA, United States
| | - Charles Rosen
- Department of Orthopaedic Surgery, University of California, Irvine, CA, United States
| | - Yu-Po Lee
- Department of Orthopaedic Surgery, University of California, Irvine, CA, United States
| | - Nitin Bhatia
- Department of Orthopaedic Surgery, University of California, Irvine, CA, United States
| |
Collapse
|
9
|
Agarwal A, Kelkar A, Agarwal AG, Jayaswal D, Schultz C, Jayaswal A, Goel VK, Agarwal AK, Gidvani S. Implant Retention or Removal for Management of Surgical Site Infection After Spinal Surgery. Global Spine J 2020; 10:640-646. [PMID: 32677561 PMCID: PMC7359681 DOI: 10.1177/2192568219869330] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
STUDY DESIGN A literature review. OBJECTIVE To summarize the implant removal rate, common bacterial organisms found, time of onset, ratio of superficial to deep infection, and regurgitating the prevalence among all the retrospective and prospective studies on management and characterization of surgical site infections (SSIs). METHODS PubMed was searched for articles published between 2000 and 2018 on the management or characterization of SSIs after spinal surgery. Only prospective and retrospective studies were included. RESULTS A total of 49 articles were found relevant to the objective. These studies highlighted the importance of implant removal to avoid recurrence of SSI. The common organisms detected were methicillin-resistant Staphylococcus aureus, methicillin-resistant Staphylococcus epidermis, Staphylococcus epidermis, Staphylococcus aureus, and Propionibacterium acnes, with prevalence of 1% to 15%. A major proportion of all were deep SSI, with minority reporting on late-onset SSI. CONCLUSION Long-term antibiotics administration, and continuous irrigation and debridement were common suggestion among the authors; however, the key measure undertaken or implied by most authors to avoid risk of recurrence was removal or replacement of implants for late-onset SSI.
Collapse
Affiliation(s)
- Aakash Agarwal
- University of Toledo, Toledo, OH, USA,Aakash Agarwal, Department of Bioengineering and Orthopaedics Surgery, University of Toledo, 5051 Nitschke Hall, MS 303, 2801 West Bancroft Street, Toledo, OH 43606, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Abstract
In July of 2018, the Second International Consensus Meeting (ICM) on Musculoskeletal Infection convened in Philadelphia, PA was held to discuss issues regarding infection in orthopedic patients and to provide consensus recommendations on these issues to practicing orthopedic surgeons. During this meeting, attending delegates divided into subspecialty groups to discuss topics specifics to their respective fields, which included the spine. At the spine subspecialty group meeting, delegates discussed and voted upon the recommendations for 63 questions regarding the prevention, diagnosis, and treatment of infection in spinal surgery. Of the 63 questions, 17 focused on the use of antibiotics in spine surgery, for which this article provides the recommendations, voting results, and rationales.
Collapse
|
11
|
Belton PJ, Litofsky NS, Humphries WE. Effect of Empiric Treatment of Asymptomatic Bacteriuria in Neurosurgical Trauma Patients on Surgical Site and Clostridium difficile Infection. Neurosurgery 2020; 85:664-671. [PMID: 30335172 DOI: 10.1093/neuros/nyy430] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 08/10/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although empiric treatment of urinary tract colonized patients remains a frequent practice in neurosurgery, the value of this practice remains debatable. OBJECTIVE To analyze the effect of screening and treatment of bacteriuria on surgical site infections, incidence of Clostridium difficile, and mortality in neurosurgical trauma patients. METHODS Database queries and direct patient chart reviews were used to gather patient chart data. T-tests, chi-square tests, binary logistic regressions, and propensity matched cohorts comparisons were performed. RESULTS A total of 3563 admitted neurosurgical trauma patients were identified over an 8 yr period (1524 cranial, 1778 spinal, and 261 combined craniospinal diagnoses). Nine hundred ninety-one patients underwent an operative neurosurgical procedure. Urinalysis was significantly associated with antibiotics exposure in both operative and nonoperative patients (P < .001). Operative patients treated with empiric antibiotics did not have a reduced risk of wound infection (P = .21), including in a propensity matched cohort (P = .52). Patients treated with empiric antibiotics had significantly increased rates of C. difficile infection (P < .001). At last follow-up, neurosurgical trauma patients that developed C. difficile had an increased risk of death (P < .005); antibiotic exposure and death were also significantly associated (P = .018). The association of C. difficile with empiric antibiotics remained significant in a propensity-matched cohort (P = .0024). CONCLUSION The routine use of urinalysis and empiric urinary antibiotics for bacteriuria in neurosurgical trauma patients without urinary symptoms increases risk of exposure to antibiotics does not decrease rates of wound infection, and is associated with increased rates of C. difficile infection and death.
Collapse
Affiliation(s)
- Patrick J Belton
- Division of Neurosurgery, Department of Surgery, University of Missouri-Columbia Medical School, Columbia, Missouri
| | | | | |
Collapse
|
12
|
Abstract
STUDY DESIGN Literature review. OBJECTIVES Surgical site infection (SSI) following spine surgery leads to significant patient morbidity, mortality, and increased health care costs. The purpose of this article is to identify risk factors and strategies to prevent SSIs following spine surgery, with particular focus on avoiding infections in posterior cervical surgery. METHODS We performed a literature review and synthesis to identify methods that can be used to prevent the development of SSI following spine surgery. Specific pearls for preventing infection in posterior cervical spine surgery are also presented. RESULTS SSI prevention can be divided into patient and surgeon factors. Preoperative patient factors include smoking cessation, tight glycemic control, weight loss, and nutrition optimization. Surgeon factors include screening and treatment for pathologic microorganisms, skin preparation using chlorhexidine and alcohol, antimicrobial prophylaxis, hand hygiene, meticulous surgical technique, frequent irrigation, intrawound vancomycin powder, meticulous multilayered closure, and use of closed suction drains. CONCLUSION Prevention of SSI following spine surgery is multifactorial and begins with careful patient selection, preoperative optimization, and meticulous attention to numerous surgical factors. With careful attention to various patient and surgeon factors, it is possible to significantly reduce SSI rates following spine surgery.
Collapse
Affiliation(s)
- Ilyas S. Aleem
- University of Michigan, Ann Arbor, MI, USA,Ilyas Aleem, Department of Orthopaedic Surgery, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
| | - Lee A. Tan
- University of California, San Francisco, CA, USA
| | | | | |
Collapse
|
13
|
Acute spinal implant infection treated with debridement: does extended antibiotic treatment improve the prognosis? Eur J Clin Microbiol Infect Dis 2019; 38:951-958. [PMID: 30904996 DOI: 10.1007/s10096-019-03537-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 03/11/2019] [Indexed: 10/27/2022]
Abstract
The study aims to determine whether 8 weeks of antibiotics is non-inferior to 12 weeks in patients with acute deep spinal implant infection (SII). In the retrospective study of all SII cases (2009-2016), patients aged ≥ 15 years with microbiologically confirmed SII treated with debridement and implant retention were included. Whenever possible, tailored antibiotic treatment was used: rifampin/linezolid in gram-positive and quinolones in gram-negative infection. Patients were divided into short treatment course (8 weeks, ST group) and extended treatment (12 weeks, ET group). Primary outcome measure was percentage of cures at 1-year follow-up. One-hundred-twenty-four patients considered, 48 excluded based on the above criteria, leaving 76 patients, 28 ST and 48 ET. There were no differences in patient age, comorbidities, underlying pathologies, infection location, or surgery characteristics between groups. Surgery-to-debridement time was similar (18.5-day ST vs. 19-day ET; P = 0.96). Sixteen SII cases (21.1%) occurred with bloodstream infection. Pathogens found were Enterobacteriaceae (35, 46.1%), Staphylococcus aureus (29, 38.2%), coagulase-negative staphylococci (12, 15.8%), Pseudomonas aeruginosa (12, 15.8%), and Enterococcus faecalis (7, 9.2%). Twenty seven (35.5%) had polymicrobial infection. E. faecalis was more frequent in the ST group (7, 25% vs. 0; P < 0.001), and P. aeruginosa in ET (1, 3.6% vs. 11, 22.9%; P = 0.05). Five patients died of causes unrelated to SII. At 1-year follow-up, cure rates (21/26 ST, 80.8% vs. 39/45 ET, 86.7%; P = 0.52) and recurrences (2/26, 7.7% vs. 2/45, 4.4%; P = 0.62) were similar. Eight-week antimicrobial courses were not inferior to 12 weeks in patients with acute deep SII treated with prompt debridement, proper wound healing, and optimized antibiotics.
Collapse
|
14
|
Tomov M, Wanderman N, Berbari E, Currier B, Yaszemski M, Nassr A, Huddleston P, Bydon M, Freedman B. An empiric analysis of 5 counter measures against surgical site infections following spine surgery-a pragmatic approach and review of the literature. Spine J 2019; 19:267-275. [PMID: 29864545 DOI: 10.1016/j.spinee.2018.05.043] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 05/04/2018] [Accepted: 05/30/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Surgical site infections (SSI) following spine surgery are debilitating complications to patients and costly to the healthcare system. PURPOSE Review the impact and cost effectiveness of 5 SSI prevention interventions on SSI rates in an orthopedic spine surgery practice at a major quaternary healthcare system over a 10-year period. STUDY DESIGN Retrospective observational study. PATIENT SAMPLE All of the surgical patients of the 5 spine surgeons in our department over a 10-year period were included in this study. OUTCOME MEASURES SSI rates per year, standardized infection ratios (SIR) for laminectomies and fusions during the most recent 3-year period, year of implementation, and frequency of use of the different interventions, cost of the techniques. METHODS The SSI prevention techniques described in this paper include application of intrawound vancomycin powder, wound irrigation with dilute betadine solution, preoperative chlorhexidine gluconate scrubs, preoperative screening with nasal swabbing, and decolonization of S. aureus, and perioperative antibiotic administration. Our institution's infection prevention and control data were analyzed for the yearly SSI rates for the orthopedic spine surgery department from 2006 to 2016. In addition, our orthopedic spine surgeons were polled to determine with what frequency and duration they have been using the different SSI prevention interventions. RESULTS SSI rates decreased from almost 6% per year the first year of observation to less than 2% per year in the final 6 years of this study. A SIR of less than 1.0 for each year was observed for laminectomies and fusions for the period from 2013 to 2016. All surgeons polled at our institution uniformly used perioperative antibiotics, Hibiclens scrub, and the nasal swab protocol since the implementation of these techniques. Some variability existed in the frequency and duration of betadine irrigation and application of vancomycin powder. A cost analysis demonstrated these methods to be nominal compared with the cost of treating a single SSI. CONCLUSIONS It is possible to reduce SSI rates in spine surgery with easy, safe, and cost-effective protocols, when implemented in a standardized manner.
Collapse
Affiliation(s)
- Marko Tomov
- Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
| | | | - Elie Berbari
- Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | | | | | - Ahmad Nassr
- Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | | | - Mohamad Bydon
- Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | | |
Collapse
|
15
|
Spina NT, Aleem IS, Nassr A, Lawrence BD. Surgical Site Infections in Spine Surgery: Preoperative Prevention Strategies to Minimize Risk. Global Spine J 2018; 8:31S-36S. [PMID: 30574435 PMCID: PMC6295818 DOI: 10.1177/2192568217752130] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
STUDY DESIGN Literature review. OBJECTIVES A review of the literature identifying preoperative risk factors for developing surgical site infections after spine surgery and discussion of the preventive strategies to minimize risks. METHODS A review of the literature and synthesis of the data to provide an updated review on the preoperative management of surgical site infection. RESULTS Preoperative prevention strategies of reducing surgical site infections in spine surgery remains a challenging problem. Careful mitigation of modifiable patient comorbidities, blood glucose control, smoking, obesity, and screening for pathologic microorganisms is paramount to reduce this risk. Individualized antibiotic regimens, skin preparation, and hand hygiene also play a critical role in surgical site infection prevention. CONCLUSIONS This review of the literature discusses the preoperative preventive strategies and risk management techniques of surgical site infections in spine surgery. Significant decreases in surgical site infections after spine surgery have been noted over the past decade due to increased awareness and implementation of the prevention strategies described in this article. However, it is important to recognize that prevention of surgical site infection requires a system-wide approach that includes the hospital system, the surgeon, and the patient. Continued efforts should focus on system-wide implementation programs including careful patient selection, individualized antibiotic treatment algorithms, identification of pathologic organisms, and preoperative decolonization programs to further prevent surgical site infections and optimize patient outcomes.
Collapse
|
16
|
Abstract
STUDY DESIGN Retrospective literature review of spine surgical site infection (SSI). OBJECTIVE To perform a review of SSI risk factors and more specifically, categorize them into patient and surgical factors. METHODS A review of published literature on SSI risk factors in adult spine surgery was performed. We included studies that reported risk factors for SSI in adult spinal surgery. Excluded are pediatric patient populations, systematic reviews, and meta-analyses. Overall, we identified 72 cohort studies, 1 controlled-cohort study, 1 matched-cohort study, 1 matched-paired cohort study, 12 case-controlled studies (CCS), 6 case series, and 1 cross-sectional study. RESULTS Patient-associated risk factors-diabetes mellitus, obesity (body mass index >35 kg/m2), subcutaneous fat thickness, multiple medical comorbidities, current smoker, and malnutrition were associated with SSI. Surgical associated factors-preoperative radiation/postoperative blood transfusion, combined anterior/posterior approach, surgical invasiveness, or levels of instrumentation were associated with increased SSI. There is mixed evidence of age, duration of surgery, surgical team, intraoperative blood loss, dural tear, and urinary tract infection/urinary catheter in association with SSI. CONCLUSION SSIs are associated with many risk factors that can be patient or surgically related. Our review was able to identify important modifiable and nonmodifiable risk factors that can be essential in surgical planning and discussion with patients.
Collapse
Affiliation(s)
- Reina Yao
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Hanbing Zhou
- University of British Columbia, Vancouver, British Columbia, Canada,Hanbing Zhou, Division of Spine Surgery, Department of Orthopaedics, University of British Columbia, 3114–910 West 10th Avenue, Vancouver, British Columbia, V5Z 1M9, Canada.
| | | | - Brian K. Kwon
- University of British Columbia, Vancouver, British Columbia, Canada
| | - John Street
- University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
17
|
Yao R, Tan T, Tee JW, Street J. Prophylaxis of surgical site infection in adult spine surgery: A systematic review. J Clin Neurosci 2018; 52:5-25. [DOI: 10.1016/j.jocn.2018.03.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 03/12/2018] [Indexed: 01/27/2023]
|
18
|
Increased infection risk after hip hemiarthroplasty in institutionalized patients with proximal femur fracture. Injury 2016; 47:872-6. [PMID: 26857632 DOI: 10.1016/j.injury.2015.12.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 12/30/2015] [Indexed: 02/06/2023]
Abstract
In patients undergoing hip hemiarthroplasty (HHA) secondary to proximal femur fracture, acute periprosthetic joint infection (PJI) is one of the most important complications. We have detected an increased risk of PJI in chronic institutionalized patients (CIPs), and a higher number of early postoperative infections are caused by Gram-negative bacteria (GNB), not covered by the current prophylaxis (cefazolin in noninstitutionalized patients (NIPs) and cotrimoxazole in CIPs). We sought to compare infection characteristics between NIPs and CIPs, analyzing predisposing factors, causative pathogens, and antibiotic prophylaxis-related microbiological characteristics. We performed a retrospective review of our prospective institutional database to identify all patients consecutively admitted for HHA to treat proximal femur fracture at our centre between 2011 and 2013. PJI was diagnosed in 21 of 381 (5.51%) patients, with 10 of 105 (9.52%) in the CIP group and 11 of 276 (3.99%) in the NIP group, and statistical significance was achieved. GNB accounted for PJI in 14 (66.67%) patients. We detected a single case of methicillin-resistant Staphylococcus aureus (MRSA) infection in the NIP group. We confirm a higher risk of acute PJI among institutionalized patients, commonly caused by Gram-negative microorganisms, which are not covered by the current prophylaxis. New prophylactic strategies should be investigated in order to reduce this problem.
Collapse
|
19
|
Latka D, Miekisiak G, Jarmuzek P, Lachowski M, Kaczmarczyk J. Treatment of lumbar disc herniation with radiculopathy. Clinical practice guidelines endorsed by The Polish Society of Spinal Surgery. Neurol Neurochir Pol 2015; 50:101-8. [PMID: 26969566 DOI: 10.1016/j.pjnns.2015.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 12/02/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Herniated lumbar disc (HLD) is arguably the most common spinal disorder requiring surgical intervention. Although the term is fairly straightforward, the exact pathology and thus the clinical picture and natural history may vary. Therefore, it is immensely difficult to formulate universal guidelines for surgical treatment. AIM The aim of this paper is to organize the terminology and clear the inconsistencies in phraseology, review treatment options and gather available published evidence to address the clinical questions to create a set of clinical guidelines in relevant to the topic. METHODS AND RESULTS Twelve queries, addressing optimal surgical treatment of the HLD have been formulated. The results, based on the literature review are described in the present work. The final product of the analysis was a set of guidelines for the surgical treatment of symptomatic HLD. Categorized into four tiers based on the level of evidence (I-III and X), they have been designed to assist in the selection of optimal, effective treatment leading to the successful outcome. CONCLUSIONS The evidence based medicine (EBM) is becoming ever more popular among spinal surgeons. Unfortunately this is not always feasible. Lack of uniform guidelines and numerous conflicts of interest introduce flaws in the decision making process. The key role of experts and professional societies is to provide high value recommendation based on the most current literature. Present work contains a set of guidelines for the surgical treatment of HLD officially endorsed by the Polish Spine Surgery Society.
Collapse
Affiliation(s)
- Dariusz Latka
- Department of Neurosurgery, Regional Medical Center, Opole, Poland.
| | - Grzegorz Miekisiak
- Department of Neurosurgery, Specialist Medical Center, Polanica-Zdroj, Poland
| | - Pawel Jarmuzek
- Department of Neurosurgery, Regional Neurosurgery and Neurotrauma Center, Zielona Gora, Poland
| | | | - Jacek Kaczmarczyk
- Department of Orthopedics and Traumatology, Poznan University of Medical Sciences, Poznan, Poland
| |
Collapse
|
20
|
Litrico S, Recanati G, Gennari A, Maillot C, Saffarini M, Le Huec JC. Single-use instrumentation in posterior lumbar fusion could decrease incidence of surgical site infection: a prospective bi-centric study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2015; 26:21-6. [DOI: 10.1007/s00590-015-1692-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 08/10/2015] [Indexed: 10/23/2022]
|
21
|
Emohare O, Ledonio CG, Hill BW, Davis RA, Polly DW, Kang MM. Cost savings analysis of intrawound vancomycin powder in posterior spinal surgery. Spine J 2014; 14:2710-5. [PMID: 24650851 DOI: 10.1016/j.spinee.2014.03.011] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 01/03/2014] [Accepted: 03/08/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Recent studies have shown that prophylactic use of intrawound vancomycin in posterior instrumented spine surgery substantially decreases the incidence of wound infections requiring repeat surgery. Significant cost savings are thought to be associated with the use of vancomycin in this setting. PURPOSE To elucidate cost savings associated with the use of intrawound vancomycin in posterior spinal surgeries using a budget-impact model. STUDY DESIGN Retrospective cohort study. PATIENT SAMPLE Data from a cohort of 303 patients who underwent spinal surgery (instrumented and noninstrumented) over 2 years were analyzed; 96 of these patients received prophylactic intrawound vancomycin powder in addition to normal intravenous (IV) antibiotic prophylaxis, and 207 received just routine IV antibiotic prophylaxis. Patients requiring repeat surgical procedures for infection were identified, and the costs of these additional procedures were elucidated. OUTCOME MEASURE Cost associated with the additional procedure to remediate infection in the absence of vancomycin prophylaxis. METHODS We retrospectively reviewed the cost of return procedures for treatment of surgical site infection (SSI). The total reimbursement received by the health care facility was used to model the costs associated with repeat surgery, and this cost was compared with the cost of a single local application of vancomycin costing about $12. RESULTS Of the 96 patients in the treatment group, the return-to-surgery rate for SSI was 0. In the group without vancomycin, seven patients required a total of 14 procedures. The mean cost per episode of surgery, based on the reimbursement, the health care facility received was $40,992 (range, $14,459-$114,763). A total of $573,897 was spent on 3% of the 207-patient cohort that did not receive intrawound vancomycin, whereas a total of $1,152 ($12×96 patients) was spent on the cohort treated with vancomycin. CONCLUSIONS This study shows a reduction in SSIs requiring a return-to-surgery-with large cost savings-with use of intrawound vancomycin powder. In our study population, the cost savings totaled more than half a million dollars.
Collapse
Affiliation(s)
- Osa Emohare
- Department of Neurosurgery, Mail Stop 11503G, Regions Hospital, 640 Jackson Street, Saint Paul, MN, 55101.
| | - Charles G Ledonio
- Department of Orthopaedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN, 55454
| | - Brian W Hill
- Department of Orthopaedic Surgery, Saint Louis University, 3635 Vista at Grand Blvd. St. Louis, Missouri 63104
| | - Rick A Davis
- Department of Orthopaedic Surgery, Mail Stop 11503L, Regions Hospital, 640 Jackson Street, Saint Paul, MN 55101
| | - David W Polly
- Department of Orthopaedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN, 55454
| | - Matthew M Kang
- Department of Neurosurgery, Mail Stop 11503G, Regions Hospital, 640 Jackson Street, Saint Paul, MN, 55101
| |
Collapse
|
22
|
Núñez-Pereira S, Rodríguez-Pardo D, Pellisé F, Pigrau C, Bagó J, Villanueva C, Cáceres E. Postoperative urinary tract infection and surgical site infection in instrumented spinal surgery: is there a link? Clin Microbiol Infect 2014; 20:768-73. [DOI: 10.1111/1469-0691.12527] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 01/07/2014] [Accepted: 01/08/2014] [Indexed: 11/29/2022]
|
23
|
Hill BW, Emohare O, Song B, Davis R, Kang MM. The use of vancomycin powder reduces surgical reoperation in posterior instrumented and noninstrumented spinal surgery. Acta Neurochir (Wien) 2014; 156:749-54. [PMID: 24570187 DOI: 10.1007/s00701-014-2022-z] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 01/30/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Surgical site infections can complicate posterior spine surgery. Multiple hospital admissions may be required to adequately treat a surgical site infection, which is associated with increased costs and lower patient satisfaction. The objective of this study was to evaluate the efficacy of prophylactic intra-wound vancomycin powder in reducing the incidence of repeat surgery for infections after posterior instrumented and noninstrumented spine surgery. METHODS A series of consecutive patients who underwent instrumented or noninstrumented posterior spine surgery for any indication by two surgeons from July 2010 to July 2012 were reviewed. The preoperative antibiotic regimens of both surgeons were identical, except that one surgeon applied 1 g vancomycin powder directly to the surgical bed before wound closure, while the other did not. Patient demographics, operative details, and rates of reoperation for wound infection in the control and the treatment groups were compared. RESULTS Both the control group and treatment group consisted of 150 patients; mean ages were 58.33 and 54.14 years, respectively. Both groups had low rates of deep infection requiring surgical intervention. The treatment group had a significantly lower rate of infection requiring reoperation or surgical debridement (0 %; 95 % CI: 0 %-2.4 %) compared with the control group (4 %; 95 % CI: 1.5 %-8.5 %) (P = 0.0297). The six infections identified in the control group resulted in 12 repeat operative debridement procedures. Gram-positive organisms were identified in 66.7 % of infections. No complications were related to the application of vancomycin powder. CONCLUSIONS The results of this study demonstrate that adjunctive vancomycin powder applied directly to the surgical bed before closure seems effective in preventing deep infections that require operative debridement following posterior spine surgery.
Collapse
|
24
|
Liu W, Neidert MC, Groen RJ, Woernle CM, Grundmann H. Third-generation cephalosporins as antibiotic prophylaxis in neurosurgery: What's the evidence? Clin Neurol Neurosurg 2014; 116:13-9. [DOI: 10.1016/j.clineuro.2013.10.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Revised: 10/17/2013] [Accepted: 10/27/2013] [Indexed: 10/26/2022]
|
25
|
Li GQ, Guo FF, Ou Y, Dong GW, Zhou W. Epidemiology and outcomes of surgical site infections following orthopedic surgery. Am J Infect Control 2013; 41:1268-71. [PMID: 23890741 DOI: 10.1016/j.ajic.2013.03.305] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Revised: 03/24/2013] [Accepted: 03/25/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Surgical site infections (SSIs) are common complications after surgeries, usually leading to increased health care costs. Therefore, we evaluated the efficiency of current preoperative antibiotic prophylaxis and risk factors of SSIs in the orthopedic wards in a major teaching hospital in China. METHODS We retrospectively reviewed a population of 2,061 patients who underwent orthopedic surgeries between January 2010 and January 2012 and examined the bacterial isolates and their resistance patterns associated with orthopedic infections. Moreover, a multivariate logistic regression was used to identify independent risk factors for SSIs. RESULTS Thirty-three out of the 45 clinical SSIs were culture positive, and a total of 35 bacterial strains was isolated, among which, 65.72% (n= 23) were gram-positive isolates, and 34.28% (n = 12) were gram-negative bacteria. Significantly, 68.6% of all bacterial isolates were resistant to cefuroxime. Additionally, this study found that diabetes mellitus (odds ratio [OR], 7.539), smoking (OR, 2.378), duration of surgeries longer than 3 hours (OR, 3.633), absence of antibiotic prophylaxis (OR, 6.562), and previous operations (OR, 2.190) were crucial independent risk factors associated with a significant increase in the development rate of SSIs following orthopedic incisional operations. CONCLUSION Our data suggested that appropriate modifications to antibiotic prophylaxis regimens should be considered. Furthermore, tightening glucose control, stopping smoking, providing proper antibiotic prophylaxis, and shortening surgery time are promising approaches to reduce the SSIs rate.
Collapse
Affiliation(s)
- Guo-qing Li
- School of Pharmaceutical Sciences, Shandong University, Jinan, China
| | | | | | | | | |
Collapse
|
26
|
Launay E, Pichenot V, Dumont R, Caillon J, Gras-Le Guen C. Antibioprophylaxie en chirurgie orthopédique pédiatrique. Arch Pediatr 2013; 20 Suppl 3:S74-8. [DOI: 10.1016/s0929-693x(13)71411-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
27
|
Núñez-Pereira S, Pellisé F, Rodríguez-Pardo D, Pigrau C, Bagó J, Villanueva C, Cáceres E. Implant survival after deep infection of an instrumented spinal fusion. Bone Joint J 2013; 95-B:1121-6. [PMID: 23908430 DOI: 10.1302/0301-620x.95b8.30784] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This study evaluates the long-term survival of spinal implants after surgical site infection (SSI) and the risk factors associated with treatment failure. A Kaplan-Meier survival analysis was carried out on 43 patients who had undergone a posterior spinal fusion with instrumentation between January 2006 and December 2008, and who consecutively developed an acute deep surgical site infection. All were appropriately treated by surgical debridement with a tailored antibiotic program based on culture results for a minimum of eight weeks. A 'terminal event' or failure of treatment was defined as implant removal or death related to the SSI. The mean follow-up was 26 months (1.03 to 50.9). A total of ten patients (23.3%) had a terminal event. The rate of survival after the first debridement was 90.7% (95% confidence interval (CI) 82.95 to 98.24) at six months, 85.4% (95% CI 74.64 to 96.18) at one year, and 73.2% (95% CI 58.70 to 87.78) at two, three and four years. Four of nine patients required re-instrumentation after implant removal, and two of the four had a recurrent infection at the surgical site. There was one recurrence after implant removal without re-instrumentation. Multivariate analysis revealed a significant risk of treatment failure in patients who developed sepsis (hazard ratio (HR) 12.5 (95% confidence interval (CI) 2.6 to 59.9); p < 0.001) or who had > three fused segments (HR 4.5 (95% CI 1.25 to 24.05); p = 0.03). Implant survival is seriously compromised even after properly treated surgical site infection, but progressively decreases over the first 24 months.
Collapse
Affiliation(s)
- S Núñez-Pereira
- St. Franziskus Hospital and Universitat Autònoma de Barcelona, Spine Surgery, Schönsteinstr 63, Cologne, Germany.
| | | | | | | | | | | | | |
Collapse
|
28
|
[Nocosomial urinary tract infections]. Enferm Infecc Microbiol Clin 2013; 31:614-24. [PMID: 23375744 DOI: 10.1016/j.eimc.2012.11.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 11/28/2012] [Indexed: 01/11/2023]
Abstract
Nosocomial urinary tract infections (UTI) are mainly related to urinary catheterisation. In this paper we review the pathogenic mechanisms, particularly the route by which the microorganisms colonise the urinary tract, their adhesion ability, and their capacity to form biofilms, and are related not only to the microorganism but also to the type of urinary catheter. The aetiology of catheter related UTI is variable, and multiresistant microorganisms are often isolated, making empirical antibiotic therapy complex. Clinical findings are frequently atypical, and its diagnosis is difficult. The therapeutic management of catheter-related UTI should be stratified according to the type of UTI: asymptomatic bacteriuria should not be habitually treated, but patients with septic shock should receive a broad spectrum antibiotic. In this review, the value of the different preventive measures are discussed.
Collapse
|
29
|
Tofuku K, Koga H, Yanase M, Komiya S. The use of antibiotic-impregnated fibrin sealant for the prevention of surgical site infection associated with spinal instrumentation. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2012; 21:2027-33. [PMID: 22820952 DOI: 10.1007/s00586-012-2435-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 06/06/2012] [Accepted: 07/05/2012] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to determine if the use of antibiotic-impregnated fibrin sealant (AFS) was effective in preventing surgical site infections (SSI) associated with spinal instrumentation. METHODS In a preliminary study, five pieces of vancomycin-impregnated fibrin sealant, five nuts that were not treated with the sealant, and five nuts that were treated with the sealant were subjected to agar diffusion testing. In a clinical study, the rates of deep SSI were compared between 188 patients who underwent procedures involving spinal instrumentation without AFS (group 1) and 196 patients who underwent procedures involving spinal instrumentation with AFS (group 2). RESULTS All five pieces of vancomycin-impregnated fibrin sealant and the five nuts treated with the sealant exhibited antimicrobial efficacy, while the five untreated nuts did not exhibit antimicrobial efficacy in the agar diffusion test. In the clinical study, 11 (5.8 %) of the 188 patients in group 1 acquired a deep SSI, while none (0 %) of the 196 patients in group 2 acquired a deep SSI. CONCLUSION The present study demonstrated that the application of AFS to spinal instrumentation yielded good clinical outcomes in terms of the prevention of postoperative spinal infections. It is hoped that limiting AFS use to patients requiring spinal instrumentation and those with risk factors for SSI will reduce the overall costs while preventing SSIs.
Collapse
Affiliation(s)
- Katsuhiro Tofuku
- Department of Orthopaedic Surgery, Imakiire General Hospital, 4-16 Shimotatsuo, Kagoshima, Japan.
| | | | | | | |
Collapse
|