BackgroundSurgical site infections following spinal surgery affect 0. 3 to 20% of patients. The longer the infection, the greater the chance of antibiotic treatment failure due to the establishment of mature microbial biofilm on the hardware, requiring its removal for infection eradication.MethodsRetrospective cohort of patients with microbiologically confirmed SII following spinal surgery treated with debridement and retention. SII was defined as the presence of clinical signs of deep surgical site infection with 2 or more positive culture results of tissue surrounding the implant taken during surgical debridement; or from CT guided biopsy. Inclusion criteria: adults with a 1º episode of microbiological confirmed SII diagnosed from 2008 to 2017 with >2 years of follow-up, treated with implant retention. Definitions Early-onset infection (EOI): infection < 1 month following implant placement. Late onset infection (LOI): between 30 days and 1 year after implant placement. Delayed onset infection (DOI): >1 year of implant placement. Statistical analysis made in Graph Pad Prism 5. 0.ResultsWe analyzed 19 patients with SII treated with hardware retention. Mean age was 54 (21–70) years, 63% were female. Comorbidities, clinical manifestations and motive for surgery are in Table 1 and Figure 1. Hardware material used was titanium 15(79%) and steel 4(21%). In addition to the hardware,11 patients (57. 9%) underwent bone grafting, 4 experienced treatment failure (4/11 = 36. 4%); 2 patients had nonmetallic material inserted (carbon polymer), the 2 patients experienced failure. 16 patients (84. 2%) had EOI, 2 (10. 5%) LOI, 1 (5. 3%) DOI. Failure requiring implant removal was observed in 26. 3% (n = 5), 2 of the cases were EOI, 2 LOI and 1 DOI. Bacterial characteristics of patients are shown in Table 2. 47,4% of patients required more than one debridement (Figure 2). In the lineal regression model, treatment failure was associated with bone grafting (P = 0. 04) and the use of carbon polymer materials (P = 0. 007).ConclusionTreatment of SII with debridement plus antimicrobials treatment is acceptable, with a rate failure of 26%. In LOI and DOI spinal implant retention is more prone to fail. Bone grafting and the presence of polymers seem to be associated with treatment failure of conservative strategies. Disclosures All authors: No reported disclosures.
P a g e 1 8 | U O J M V o l u m e 7 I s s u e 1 | M a y 2 0 1 7 Les utilisateurs de drogues injectables (UDIs) ayant besoin d'une antibiothérapie par voie parentérale ambulatoire (APA) pour des infections associées aux injections se voient fréquemment refuser l'accès à un cathéter central à insertion périphérique (PICC, de l'anglais) puisqu'on présume qu'ils l'utiliseront pour s'injecter des drogues illicites, et que le cathéter sera utilisé de manière non stérile ou peu hygiénique. Bien que les UDIs présentent des taux plus élevés d'endocardite infectieuse, d'abcès et de septicémie, il n'existe pas de preuves substantielles qui démontrent que les PICCs chez les UDIs entraînent des infections plus sévères, ou une hausse de surdoses, de morbidité ou de mortalité. La transition réussie des UDIs d'un traitement hospitalier vers une APA exige une sélection attentive des patients. Notamment, la situation de logement, les antécédents de santé mentale, la présence d'un système de soutien et la volonté du patient de suivre le traitement contribuent tous au succès de l'APA. Des conversations honnêtes et directes doivent avoir lieu entre le patient et le fournisseur de soins quant aux risques et aux avantages d'un PICC et de l'utilisation de drogues injectables. Un suivi étroit, une approche compatissante, la formation appropriée des fournisseurs de soins, et l'expansion des programmes de répit constituent tous de nouvelles façons de réduire les méfaits et d'améliorer les soins aux patients. Finalement, plus de recherche est nécessaire afin de mettre en place des protocoles, des lignes directrices, des critères de dépistage et des transitions de soins, et pour clarifier les pratiques exemplaires quant à l'APA chez les patients qui utilisent des drogues injectables. C o m m e n t a r y BT lay with her head cocked in the only comfortable position, her thin legs protruding below flimsy hospital sheets. I was on a rotation in Infectious Diseases based at several Toronto-area hospitals and she was not my first intravenous (IV) drug-using patient. She was, however, the first patient I had seen who was unable to move her head more than several millimeters in either direction since a paraspinal abscess precariously abutted her spinal cord. BT could be argumentative-she had yelled at several nurses and often refused to have her vital signs taken. She also told me she was scared-she recognized that finding herself in this position was likely secondary to her IV drug use. Despite delivering attentive care, some of the nurses rolled their eyes when talking about Injection drug users (IDUs) requiring outpatient parenteral antibiotic therapy (OPAT) for injection-related infections are regularly denied the use of peripherally inserted central catheter (PICC) lines based on the assumption that they will use the port to inject illicit drugs, and that it will be used in a non-sterile/unclean fashion. While IDUs have higher rates of infective endocarditis, abscesses and septicemia, there is no substantial body of evidence that PICC lines in...
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