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Wei J, Brown C, Moore T, Graham N, Davis M, Gatehouse S, Nourse C. Implant-associated Infection After Pediatric Spine Deformity Surgery: Is Removal of Hardware Indicated? Pediatr Infect Dis J 2024; 43:333-338. [PMID: 38100726 DOI: 10.1097/inf.0000000000004218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
BACKGROUND Postoperative spinal implant infection following pediatric spinal surgery often presents a management dilemma. We aimed to characterize our experience in this cohort of patients, hoping to provide further insight when approaching these challenging cases. METHODS A retrospective, observational study was performed of all children who underwent spinal surgery from January 2015 to June 2021 in a tertiary pediatric spinal surgery referral center in Queensland, Australia. Records were reviewed to identify cases of postoperative surgical site infection, with particular focus on children with infection directly involving implants. Preoperative prophylaxis, microbiology, clinical course and outcomes were analyzed. RESULTS A total of 580 children underwent 933 procedures during the study period. The most common pathology requiring surgery was idiopathic scoliosis in 257 children (44.3%) followed by neuromuscular scoliosis in 192 children (33.1%). There were 35 cases of surgical site infection (6.03%), and 9 were implant-associated (1.55%). Infection rate among children with neuromuscular spinal deformity was almost 3-fold higher (11.5%) than idiopathic (3.89%). Methicillin-sensitive Staphylococcus aureus was the most commonly isolated organism (n = 15). Four implant-associated infections were successfully managed with retention of implant; all were diagnosed within 32 days (median = 20 days) and cultured either Staphylococcus aureus or Pseudomonas aeruginosa . Conversely, infections that necessitated implant removal had a more indolent onset (median = 175 days), and more often cultured Cutibacterium acnes and coagulase-negative Staphylococci . CONCLUSIONS Postoperative spinal implant infection can be treated successfully with hardware retention in select cases. Earlier presentation and recognition appear to be associated with better rates of retention and are linked to certain organisms. Further exploration of specific preventative strategies may be key in preventing devastating late-onset infections.
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Affiliation(s)
- Jou Wei
- From the Queensland Children's Hospital
| | | | - Tomas Moore
- Graduate Medical School, University of Queensland
| | | | | | | | - Clare Nourse
- From the Queensland Children's Hospital
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
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Núñez-Pereira S, Benavent E, Ulldemolins M, Sobrino-Díaz B, Iribarren JA, Escudero-Sánchez R, Del Toro MD, Nodar A, Sorli L, Bahamonde A, Vilchez HH, Gasch O, Muñez E, Rodríguez-Montserrat D, García-País MJ, Haddad S, Sellarès-Nadal J, Murillo O, Rodríguez-Pardo D. Cutibacterium spp. Infections after Instrumented Spine Surgery Have a Good Prognosis Regardless of Rifampin Use: A Cross-Sectional Study. Antibiotics (Basel) 2023; 12:antibiotics12030518. [PMID: 36978385 PMCID: PMC10044575 DOI: 10.3390/antibiotics12030518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 02/25/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
Infection after spinal instrumentation (IASI) by Cutibacterium spp. is being more frequently reported. The aim of this study was to analyse the incidence, risk factors, clinical characteristics, and outcome of a Cutibacterium spp. IASI (CG) compared with non-Cutibacterium IASI (NCG) infections, with an additional focus on the role of rifampin in the treatment. All patients from a multicentre, retrospective, observational study with a confirmed IASI between January 2010 and December 2016 were divided into two groups: (CG and NCG) IASI. Baseline, medical, surgical, infection treatment, and follow-up data were compared for both groups. In total, 411 patients were included: 27 CG and 384 NCG. The CG patients were significantly younger. They had a longer median time to diagnosis (23 vs. 13 days) (p = 0.025), although 55.6% debuted within the first month after surgery. Cutibacterium patients were more likely to have the implant removed (29.6% vs. 12.8%; p = 0.014) and received shorter antibiotic regimens (p = 0.014). In 33% of Cutibacterium cases, rifampin was added to the baseline therapy. None of the 27 infections resulted in treatment failure during follow-up regardless of rifampin use. Cutibacterium spp. is associated with a younger age and may cause both early and late IASIs. In our experience, the use of rifampin to improve the outcome in the treatment of a Cutibacterium spp. IASI is not relevant since, in our series, none of the cases had therapeutic failure regardless of the use of rifampin.
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Affiliation(s)
- Susana Núñez-Pereira
- Spine Unit, Orthopaedic Surgery Department, Vall d’Hebron University Hospital, 08035 Barcelona, Spain
- Correspondence: (S.N.-P.); (D.R.-P.); Tel.: +34-934893480 (S.N.-P)
| | - Eva Benavent
- Infectious Diseases Department, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Marta Ulldemolins
- Infectious Diseases Department, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Beatriz Sobrino-Díaz
- Department of Infectious Diseases, Hospital Regional Universitario Málaga, 29011 Málaga, Spain
| | - José A. Iribarren
- Infectious Diseases Department, Hospital Universitario Donostia, 20014 Gipuzkoa, Spain
| | - Rosa Escudero-Sánchez
- Infectious Disease Department, University Hospital Ramón y Cajal, 28034 Madrid, Spain
- CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Av. de Monforte de Lemos, 5, 28029 Madrid, Spain
| | - María Dolores Del Toro
- CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Av. de Monforte de Lemos, 5, 28029 Madrid, Spain
- Infectious Diseases Unit, Hospital Universitario Virgen Macarena, 41009 Seville, Spain
- Departamento de Medicina, Instituto de Biomedicina de Sevilla (IBiS), Universidad de Sevilla, 41009 Seville, Spain
| | - Andrés Nodar
- Infectious Diseases Unit, Internal Medicine Department, 36312 Vigo, Spain
- Instituto de Investigación Biomédica Galicia Sur, Hospital Álvaro Cunqueiro, 36312 Vigo, Spain
| | - Luisa Sorli
- CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Av. de Monforte de Lemos, 5, 28029 Madrid, Spain
- Infectious Diseases Department, Hospital del Mar, 08003 Barcelona, Spain
- Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), CEXS-Universitat Pompeu Fabra, 08003 Barcelona, Spain
| | - Alberto Bahamonde
- Department of Internal Medicine-Infectious Diseases, Hospital Universitario del Bierzo, 24411 Ponferrada, Spain
| | - Helem H. Vilchez
- Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitario Son Espases, 07120 Palma de Mallorca, Spain
| | - Oriol Gasch
- Infectious Diseases Department, Hospital Parc Tauli de Sabadell, University Autonoma of Barcelona, 08208 Barcelona, Spain
| | - Elena Muñez
- Infectious Diseases Unit, Internal Medicine Department, Hospital Puerta de Hierro-Majadahonda, 28222 Madrid, Spain
| | | | - María José García-País
- Infectious Disease Unit and Microbiology Departments, Hospital Universitario Lucus Augusti, 27003 Lugo, Spain
| | - Sleiman Haddad
- Spine Unit, Orthopaedic Surgery Department, Vall d’Hebron University Hospital, 08035 Barcelona, Spain
| | - Julia Sellarès-Nadal
- Infectious Diseases Department, Vall d’Hebron, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain
- Medicine Department, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Oscar Murillo
- Infectious Diseases Department, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
- CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Av. de Monforte de Lemos, 5, 28029 Madrid, Spain
| | - Dolors Rodríguez-Pardo
- CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Av. de Monforte de Lemos, 5, 28029 Madrid, Spain
- Infectious Diseases Department, Vall d’Hebron, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain
- Medicine Department, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
- Correspondence: (S.N.-P.); (D.R.-P.); Tel.: +34-934893480 (S.N.-P)
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