A Retrospective Analysis of Deep Surgical Site Infection Treatment after Instrumented Spinal Fusion with the Use of Supplementary Local Antibiotic Carriers

Janssen, Daniël M C; Kramer, Maud; Geurts, Jan; Rhijn, L. van; Walenkamp, G. H. I. M.; Willems, Paul

doi:10.7150/jbji.23832

Cited by 10 publications

(6 citation statements)

References 36 publications

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“…Such results suggest that the use of local antibiotic therapy was therefore of minimal or no impact on rates of failure, further supporting the hypothesis that the association between antibiotic bead and negative surgical outcomes in our study represents an indirect measure of wound severity rather than a consequence of the therapy itself. 27,28 Overall, our results are consistent with and contribute to the current literature surrounding management of wounds in this population by plastic and reconstructive surgical teams. Although not the largest study of patients with reconstruction of complex surgical spinal wounds, our study is the first to fully analyze the association of positive bacterial wound cultures at multiple time points throughout the management of infected surgical spinal wounds.…”

Section: Discussionsupporting

confidence: 88%

“…Other studies have shown positive outcomes from local antibiotic therapy; however, these studies had rates of failure to ours despite the use of local antibiotic therapy in nearly all patients being studied. Such results suggest that the use of local antibiotic therapy was therefore of minimal or no impact on rates of failure, further supporting the hypothesis that the association between antibiotic bead and negative surgical outcomes in our study represents an indirect measure of wound severity rather than a consequence of the therapy itself 27,28 …”

Section: Discussionsupporting

confidence: 82%

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Positive Bacterial Cultures on Spinal Wound Closure Do Not Predict Postoperative Outcomes

VanDolah,

Li,

Kim

et al. 2024

Ann Plast Surg

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Background Complex surgical back wounds represent significant morbidity in patients who have undergone spinal procedures requiring closure or revision by plastic surgeons. This study aimed to assess the utility of bacterial wound culture data for predicting surgical outcomes of wound management. Methods This study is a single-institution retrospective review of consecutive patients who required plastic surgery intervention for wound infection following spinal procedures between the years 2010 and 2021 (n = 70). Statistical analysis was performed for demographics, comorbidities, perioperative laboratory studies, and treatment methods. The primary outcomes of interest were rate of postoperative complications after soft tissue reconstruction and reconstructive failure. The secondary outcome of interest was time to healing in number of days. Results The overall complication rate after wound closure was 31.4%, with wound infection in 12.9%, seroma in 10%, dehiscence in 12.9%, and hematoma in 1.4%. Increasing number of debridements before wound closure increased the likelihood of a surgical complication of any kind (odds ratio [OR], 1.772; 95% confidence interval [CI], 1.045–3.002). Positive wound cultures before reconstruction were associated with development of seroma only (OR, 0.265; 95% CI, 0.078–0.893). Use of incisional vacuum-assisted closure devices significantly decreased the odds of postoperative wound dehiscence (OR, 0.179; 95% CI, 0.034–0.904) and increased odds of healing (hazard ratio, 3.638; 95% CI, 1.547–8.613). Conclusions Positive wound cultures were not significantly associated with negative outcomes after complex closure or reconstruction of infected spinal surgical wounds. This finding emphasizes the importance of clinical judgment with a multidisciplinary approach to complex surgical back wounds over culture data for wound closure timing.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 82%

Positive Bacterial Cultures on Spinal Wound Closure Do Not Predict Postoperative Outcomes

VanDolah,

Li,

Kim

et al. 2024

Ann Plast Surg

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“…Surgical site infection (SSI) is one of the most serious complications after spine surgery with potentially devastating consequences such as failure of fixation, osteomyelitis, pseudarthrosis, increased length of hospital stay, mortality, unfavorable surgical outcome and associated health care costs [1][2][3][4][5]. Within the field of orthopedic surgery, a relatively high incidence of SSIs is observed after spine surgery: up to 12% depending on diagnosis, surgical approach, use of spinal instrumentation and the complexity of the procedure [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

A prediction model of surgical site infection after instrumented thoracolumbar spine surgery in adults

et al. 2019

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The aim of this study was to develop and internally validate a multivariable model for accurate prediction of surgical site infection (SSI) after instrumented spine surgery using a large cohort of a Western European academic center. Method Data of potential predictor variables were collected in 898 adult patients who underwent instrumented posterior fusion of the thoracolumbar spine. We used logistic regression analysis to develop the prediction model for SSI. The ability to discriminate between those who developed SSI and those who did not was quantified as the area under the receiver operating characteristic curve (AUC). Model calibration was evaluated by visual inspection of the calibration plot and by computing the Hosmer and Lemeshow goodness-of-fit test. Results Sixty patients (6.7%) were diagnosed with an SSI. After backward stepwise elimination of predictor variables, we formulated a model in which an individual's risk of an SSI can be computed. Age, body mass index, ASA score, degenerative or revision surgery and NSAID use appeared to be independent predictor variables for the risk of SSI. The AUC was 0.72 (95% CI 0.65-0.79), indicating reasonable discriminative ability. Conclusions We developed and internally validated a prediction model for SSI after instrumented thoracolumbar spine surgery using predictor variables of standard clinical practice that showed reasonable discriminative ability and calibration. Identification of patients at risk for SSI allows for individualized patient risk assessment with better patient-specific counseling and may accelerate the implementation of multidisciplinary strategies for reduction of SSI.

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“…To take the advantage of the function of the spacer and the high antibiotic concentration of gentamicin loaded PMMA beads it is also possible to combine both local antibiotics, whereby the spacer avoid to use that many beads as possible in a situation without a spacer. 38 This study has several limitations. First, this study used a standard mixing method that still could have led to variability in PMMA cement porosity and pharmacokinetic release profiles.…”

Section: Discussionmentioning

confidence: 92%

“…For future research these resorbable beads should also be examined for pharmacokinetic release profiles. To take the advantage of the function of the spacer and the high antibiotic concentration of gentamicin loaded PMMA beads it is also possible to combine both local antibiotics, whereby the spacer avoid to use that many beads as possible in a situation without a spacer 38 …”

Section: Discussionmentioning

confidence: 99%

Antibiotic release from PMMA spacers and PMMA beads measured with ELISA: Assessment of in vitro samples and drain fluid samples of patients

Janssen

Willems

Geurts

et al. 2023

Journal Orthopaedic Research

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For prosthetic joint infections, antibiotic loaded poly methyl methacrylate (PMMA) spacer or beads can be used to release high concentrations of antibiotics locally at the infection site, while minimizing systemic toxicity. The aim of this study is to determine in vitro and in vivo pharmacokinetic release profile of antibiotics from PMMA spacers and PMMA beads. For the in vitro experiment, the PMMA spacers or beads were submerged in phosphate‐buffered saline and gentamicin concentrations were determined from collected specimen at several times points, measured with enzyme‐linked immunosorbent assays (ELISA). To assess the in vivo antibiotic release profile of different spacers, wound drainage fluid samples were collected after implantation of a spacer over a period of maximum 14 days. After 48 h, the burst gentamicin concentration elution was 9862 ± 1782 ng/ml (mean ± SD) from spacers versus 38,394 ± 7071 ng/ml (mean ± SD) for beads. Over 35 days, spacers had eluted a cumulative mean concentration of 13,812 ± 3548 versus 55,048 ± 12,006 ng/ml for beads (p < 0.001). Clinical samples of patients with a Vancogenx® spacer showed higher gentamicin release than Refobacin™ spacers (p < 0.001). This is the first study that measured the release data of local antibiotics with ELISA. Compare to spacers, the exact release values of gentamicin from PMMA beads are more than 10 times higher and reached a maximum much later than spacers. This makes the use of PMMA beads more preferable to use for treatment of the infection itself.

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A Retrospective Analysis of Deep Surgical Site Infection Treatment after Instrumented Spinal Fusion with the Use of Supplementary Local Antibiotic Carriers

Cited by 10 publications

References 36 publications

Positive Bacterial Cultures on Spinal Wound Closure Do Not Predict Postoperative Outcomes

Positive Bacterial Cultures on Spinal Wound Closure Do Not Predict Postoperative Outcomes

A prediction model of surgical site infection after instrumented thoracolumbar spine surgery in adults

Antibiotic release from PMMA spacers and PMMA beads measured with ELISA: Assessment of in vitro samples and drain fluid samples of patients

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