Analysis of Postoperative Thoracolumbar Spine Infections in a Prospective Randomized Controlled Trial Using the Centers for Disease Control Surgical Site Infection Criteria

McClelland, Shearwood; Takemoto, Richelle; Lonner, Baron S.; Andres, Tate M.; Park, Justin J.; Ricart-Hoffiz, Pedro; Bendo, John A.; Goldstein, Jeffrey A.; Spivak, Jeffrey M.; Errico, Thomas J.

doi:10.14444/3014

Cited by 32 publications

(33 citation statements)

References 25 publications

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“…16 As shown in Table 2, the SSI incidence rate could be argued to be a result of varied spinal surgical practices and reporting methods, including differences in prophylactic measures, quality of hospital facilities, duration of follow-up, and the country of practice at the minimum. 7,[57][58][59][60][61] Besides physical examination, common diagnostic tools used to detect infection are imaging (computed tomography and magnetic resonance imaging), blood culture, C-reactive protein, erythrocyte sedimentation rate, white blood cell count, and other inflammatory biomarkers. Many of these methods provide high positive predictive value but relatively lower negative predictive value.…”

Section: Discussionmentioning

confidence: 99%

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Implant Retention or Removal for Management of Surgical Site Infection After Spinal Surgery

Agarwal

Kelkar

Agarwal

et al. 2019

Global Spine Journal

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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.

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Section: Discussionmentioning

confidence: 99%

“…As shown in Table 2 , the SSI incidence rate could be argued to be a result of varied spinal surgical practices and reporting methods, including differences in prophylactic measures, quality of hospital facilities, duration of follow-up, and the country of practice at the minimum. 7 , 57 - 61 …”

Section: Discussionmentioning

confidence: 99%

Implant Retention or Removal for Management of Surgical Site Infection After Spinal Surgery

Agarwal

Kelkar

Agarwal

et al. 2019

Global Spine Journal

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show abstract

“…Prevention (CDC). 1 In addition to its clinical presentation, there have been several studies performed on occult forms of SSI. [2][3][4][5] According to literature data, these occult SSIs were present in at least 10%-30% of patients with chronic pain and were detected only during revision spine surgery.…”

Section: Introductionmentioning

confidence: 99%

Updates on Evidence-Based Practices to Reduce Preoperative and Intraoperative Contamination of Implants in Spine Surgery: A Narrative Review

Agarwal

Lin

Elgafy

et al. 2020

Spine Surg Relat Res

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“…The average hospitalization cost resulting from such infections is $63 000 per case at an average frequency of 5.5% of cases (built in cost of $3465 for every surgery). 1,2 Consequently, in recent years, there has been considerable interest in refining aseptic techniques, such as intraoperative handling of implantable devices, in order to reduce the bioburden being transmitted to the patients, a majority of whom are also immunocompromised. Researchers have already detected colony-forming units (CFUs) of bacteria on exposed sterile implants and the gloves from the surgeon, scrub nurse, and assistants.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Intraoperative Implant Prophylaxis in Reducing Intraoperative Microbial Contamination

Agarwal

Lin

Wang

et al. 2018

Global Spine Journal

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Study Design:A prospective single-center study.Objectives:Assess to what degree contamination of pedicle screws occur in standard intraoperative practice and if use of an impermeable guard could mitigate or reduce such an occurrence.Methods:Two groups of sterile prepackaged pedicle screws, one with an intraoperative guard (group 1) and the other without such a guard (group 2), each consisting of 5 samples distributed over 3 time points, were loaded onto the insertion device by the scrub tech and left on the sterile table. Approximately 20 minutes later, the lead surgeon who had just finished preparing the surgical site touches the pedicle screw. Then instead of implantation it was transferred to a sterile container using fresh clean gloves for bacterial and gene analysis. Guarded screw implies that even after unwrapping from the package, the screw carries an impermeable barrier along its entire length, which is only removed seconds prior to implantation.Results:The standard unguarded pedicle screws presented bioburden in the range of 105 to 107 (colony forming units/implant) with bacterial genus mostly consisting of Staphylococcus and Micrococcus, the 2 most common genera found in surgical site infection reports. The common species among them were Staphylococcus epidermis, Staphylococcus aureus, Micrococcus luteus, and Staphylococcus pettenkoferi, whereas the guarded pedicle screws showed no bioburden.Conclusions:Shielding the pedicle screws intraoperatively using a guard provides a superior level of asepsis than currently practiced. All unshielded pedicles screws were carrying bioburden of virulent bacterial species, which provides an opportunity for the development of postoperative infections.

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Analysis of Postoperative Thoracolumbar Spine Infections in a Prospective Randomized Controlled Trial Using the Centers for Disease Control Surgical Site Infection Criteria

Cited by 32 publications

References 25 publications

Implant Retention or Removal for Management of Surgical Site Infection After Spinal Surgery

Implant Retention or Removal for Management of Surgical Site Infection After Spinal Surgery

Updates on Evidence-Based Practices to Reduce Preoperative and Intraoperative Contamination of Implants in Spine Surgery: A Narrative Review

Efficacy of Intraoperative Implant Prophylaxis in Reducing Intraoperative Microbial Contamination

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