Infection with spinal instrumentation: Review of pathogenesis, diagnosis, prevention, and management

Kasliwal, Manish K.; Tan, Lee A.; Traynelis, Vincent C.

doi:10.4103/2152-7806.120783

Cited by 97 publications

(80 citation statements)

References 145 publications

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“…When assessed by type of spine surgery, SSI rate for instrumented spinal fusion was higher than for spinal fusion and spinal decompression. This coincides with previously published reports that suggest that the higher SSI rate associated with this type of spine surgical procedure is partly attributed to its greater complexity (e.g., longer duration of surgical procedure, increased need for instrumentation, retractor usage, and soft tissue dissection) [5]. Furthermore, when evaluating the time of onset of SSI after the index spine surgical procedure, the higher pooled average rate for early versus late infections (2.1% versus 0.8%) suggests that the first 30 d are the most crucial period for acquiring SSIs.…”

Section: Discussionsupporting

confidence: 91%

Burden of Surgical Site Infections Associated with Select Spine Operations and Involvement ofStaphylococcus aureus

Patel¹,

Khoury²,

Girgenti

et al. 2017

Surgical Infections

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Background: Spine operations may be indicated for treatment of diseases including vertebral injuries, degenerative spinal conditions, disk disease, spinal misalignments, or malformations. Surgical site infection (SSI) is a clinically important complication of spine surgery. Staphylococcus aureus, including methicillin-resistant Staphylococcus aureus (MRSA), is a leading cause of post-spinal SSIs.Methods: PubMed and applicable infectious disease conference proceedings were searched to identify relevant published studies. Overall, 343 full-text publications were screened for epidemiologic, mortality, health care resource utilization, and cost data on SSIs associated with specified spine operations.Results: Surgical site infection rates were identified in 161 studies from North America, Europe, and Asia. Pooled average SSI and S. aureus SSI rates for spine surgery were 1.9% (median, 3.3%; range, 0.1%–22.6%) and 1.0% (median, 2.0%; range, 0.02%–10.0%). Pooled average contribution of S. aureus infections to spinal SSIs was 49.3% (median, 50.0%; range, 16.7%–100%). Pooled average proportion of S. aureus SSIs attributable to MRSA was 37.9% (median, 42.5%; range, 0%–100%). Instrumented spinal fusion had the highest pooled average SSI rate (3.8%), followed by spinal decompression (1.8%) and spinal fusion (1.6%). The SSI-related mortality rate among spine surgical patients ranged from 1.1%–2.3% (three studies). All studies comparing SSI and control cohorts reported longer hospital stays for patients with SSIs. Pooled average SSI-associated re-admission rate occurring within 30 d from discharge ranged from 20% to 100% (four studies). Pooled average SSI-related re-operation rate was 67.1% (median, 100%; range, 33.5%–100%). According to two studies reporting direct costs, spine surgical patients incur approximately double the health care costs when they develop an SSI.Conclusions: Available published studies demonstrate a clinically important burden of SSIs related to spine operations and the substantial contribution of S. aureus (including MRSA). Preventive strategies aimed specifically at S. aureus SSIs could reduce health care costs and improve patient outcomes for spine operations.

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Section: Discussionsupporting

confidence: 91%

Burden of Surgical Site Infections Associated with Select Spine Operations and Involvement ofStaphylococcus aureus

Patel¹,

Khoury²,

Girgenti

et al. 2017

Surgical Infections

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“…Most of the time the infection is due to an exogenous contamination [121415]. A suitable antibiotic for an appropriate period is mandatory, but prolonged use of prophylactic antibiotics should be avoided [16171819]. There are many articles emphasizing compliance which show that surgical care improvement projects do minimize or influence SSIs [1920].…”

Section: Discussionmentioning

confidence: 99%

Antimicrobial Prophylaxis in Instrumented Spinal Fusion Surgery: A Comparative Analysis of 24-Hour and 72-Hour Dosages

et al. 2016

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Study DesignProspective study.PurposeTo compare the efficacy of 24-hour and 72-hour antibiotic prophylaxis in preventing surgical site infections (SSIs).Overview of LiteratureAntimicrobial prophylaxis in surgical practice has become a universally accepted protocol for minimizing postoperative complications related to infections. Although prophylaxis is an accepted practice, a debate exists with regard to the antibiotic type and its administration duration for various surgical procedures.MethodsOur institute is a tertiary care hospital with more than 100 spinal surgeries per year for various spine disorders in the department of orthopedics. We conducted this prospective study in our department from June 2012 to January 2015. A total of 326 patients were enrolled in this study, with 156 patients in the 72-hour antibiotic prophylaxis group (group A) and 170 patients in the 24-hour group (group B). Cefazolin was the antibiotic used in both groups. Two surgeons were involved in conducting all the spinal procedures. Our study compared SSIs among patients undergoing instrumented spinal fusion.ResultsThe overall rate of SSIs was 1.8% with no statistical difference between the two groups.ConclusionsThe 24-hour antimicrobial prophylaxis is as effective as the 72-hour dosage in instrumented spinal fusion surgery.

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“…Conversely, all patients with cobalt chrome and titanium rods underwent vacuum-assisted wound closure. This difference in protocol is based on previous research suggesting higher risk of infection in patients instrumented with stainless steel instrumentation [10]. When looking at the timing of surgery after our institution implemented (since 2012) the formal use of topical vancomycin with or without tobramycin at the initial time of surgery, no statistically significant difference was seen with the incidence of wound infection ( p = 0.796).…”

Section: Resultsmentioning

confidence: 94%

Risk Factors for Wound Infections after Deformity Correction Surgery in Neuromuscular Scoliosis

et al. 2019

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Objective: This study aims to elucidate surgical risk factors in neuromuscular scoliosis (NMS) with respect to wound site infection after spinal fusion. Methods: A retrospective review was performed of all patients treated surgically for NMS between January 2008 and December 2016 (minimum 6 months’ follow-up). A sub-cohort of 60 patients with minimum 2 years of follow-up data was also analyzed. Results: In 102 patients (53 boys and 49 girls), the mean age at surgery was 14.0 years (SD ±2.7). Mean follow-up was 2.53 years (±1.66), and mean time to presentation of infection was 2.14 months (±4.95). The overall perioperative complication rate was 26.5%, with 14.7% of patients developing deep wound infection. Gram-negative bacteria were responsible for 60% of infections; 20% were Gram positive, and 20% involved both types. Pulmonary comorbidities (p = 0.007), pre- to postoperative increase in weight (p = 0.010), exaggerated lumbar lordosis at follow-up (p = 0.008), history of seizures (p = 0.046), previous myelomeningocele repair (p = 0.046), and previous operations (p = 0.013) were significant risk factors for infection. Conclusion: Our data suggest that in the pediatric population treated surgically for NMS, wound infection is strongly associated with postoperative increase in body weight, residual lumbar lordosis, pulmonary comorbidity, history of myelomeningocele repair, seizures, and previous operations.

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Infection with spinal instrumentation: Review of pathogenesis, diagnosis, prevention, and management

Cited by 97 publications

References 145 publications

Burden of Surgical Site Infections Associated with Select Spine Operations and Involvement ofStaphylococcus aureus

Burden of Surgical Site Infections Associated with Select Spine Operations and Involvement ofStaphylococcus aureus

Antimicrobial Prophylaxis in Instrumented Spinal Fusion Surgery: A Comparative Analysis of 24-Hour and 72-Hour Dosages

Risk Factors for Wound Infections after Deformity Correction Surgery in Neuromuscular Scoliosis

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