Postprocedural discitis of the vertebral spine: challenges in diagnosis, treatment and prevention

McDermott, H.; Bolger, Ciarán; Humphreys, Hilary

doi:10.1016/j.jhin.2012.07.009

Cited by 16 publications

(12 citation statements)

References 56 publications

(50 reference statements)

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“…Additional risk factors for SSI with Gram-negative bacteria include bladder or fecal incontinence, a previous history of long hospital admission and a posterior lumbosacral surgical approach ( 51 ). A history of intravenous drug use has also been associated with an increased risk of Gram-negative pathogens ( 9 , 52 ). Recognizing all these risk factors would help in guiding empirical antimicrobial therapy pending culture results.…”

Section: Microbial Etiologymentioning

confidence: 99%

“…First, this organism is considered as a low virulence skin organism, and thus is ignored in some cases to be the causative agent in SSI. Second, P. acnes is a slow growing microorganism that requires extended incubation time for growth ( 52 ). Thus, when this organism is suspected, several deep tissue specimens should be obtained and cultured for extended periods.…”

Section: Microbial Etiologymentioning

confidence: 99%

“…Although the usual duration between the invasive procedure and the occurrence of the infection ranges from 2 to 30 days ( 57 ), many indolent organisms like P. acnes, Serratia marcescens , diphtheroids, and coagulase-negative staphylococci classically present after 30 days ( 34 ). In addition, patients may not seek early medical attention since infection may present initially with minimal back pain as the only clinical finding and the lack of prompt medical follow-up after the procedure may therefore aggravate the problem ( 28 , 52 ).…”

Section: Diagnosismentioning

confidence: 99%

“…The use of additional staining for fungi and mycobacteria is highly advised, especially with previous negative culture results ( 87 – 90 ). Third, a delay in antibiotic therapy is recommended in order to achieve a better culture yield of aspirated specimens ( 52 ). This should be balanced with potential consequences of delayed treatment.…”

Section: Diagnosismentioning

confidence: 99%

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Surgical Site Infections Following Spine Surgery: Eliminating the Controversies in the Diagnosis

2014

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Surgical site infection (SSI) following spine surgery is a dreaded complication with significant morbidity and economic burden. SSIs following spine surgery can be superficial, characterized by obvious wound drainage or deep-seated with a healed wound. Staphylococcus aureus remains the principal causal agent. There are certain pre-operative risk factors that increase the risk of SSI, mainly diabetes, smoking, steroids, and peri-operative transfusions. Additionally, intra-operative risk factors include surgical invasiveness, type of fusion, implant use, and traditional instead of minimally invasive approach. A high level of suspicion is crucial to attaining an early definitive diagnosis and initiating appropriate management. The most common presenting symptom is back pain, usually manifesting 2–4 weeks and up to 3 months after a spinal procedure. Scheduling a follow-up visit between weeks 2 and 4 after surgery is therefore necessary for early detection. Inflammatory markers are important diagnostic tools, and comparing pre-operative with post-operative levels should be done when suspecting SSIs following spine surgery. Particularly, serum amyloid A is a novel inflammatory marker that can expedite the diagnosis of SSIs. Magnetic resonance imaging remains the diagnostic modality of choice when suspecting a SSI following spine surgery. While 18F-fluorodeoxyglucose-positron emission tomography is not widely used, it may be useful in challenging cases. Despite their low yield, blood cultures should be collected before initiating antibiotic therapy. Samples from wound drainage should be sent for Gram stain and cultures. When there is a high clinical suspicion of SSI and in the absence of superficial wound drainage, computed tomography-guided aspiration of paraspinal collections is warranted. Unless the patient is hemodynamically compromised, antibiotics should be deferred until proper specimens for culture are secured.

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Section: Microbial Etiologymentioning

confidence: 99%

Section: Microbial Etiologymentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

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Surgical Site Infections Following Spine Surgery: Eliminating the Controversies in the Diagnosis

2014

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“…The reported infection rate following spinal surgery varies between 0.5% and 18.8% and is dependent mostly on patient population and the procedure performed ( Beiner et al, 2003 ; Chahoud et al, 2014 ; Smith et al, 2011 ). Patients with a history of trauma, diabetes, advanced age or neuromuscular scoliosis are the groups with the highest risk ( Aleissa et al, 2011 ; McDermott et al, 2012 ; Smith et al, 2011 ; Sponseller et al, 2013 , 2000 ). Removal of the implanted materials is often not feasible due to the risk of spine destabilization, necessitating repeated surgical interventions and prolonged antibiotic therapy.…”

Section: Introductionmentioning

confidence: 99%

Rabbit model of Staphylococcus aureus implant-associated spinal infection

Gordon

Miller

Thompson

et al. 2020

Disease Models &Amp; Mechanisms

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Post-surgical implant-associated spinal infection is a devastating complication commonly caused by Staphylococcus aureus. Biofilm formation is thought to reduce penetration of antibiotics and immune cells, contributing to chronic and difficult-to-treat infections. A rabbit model of a posterior-approach spinal surgery was created, in which bilateral titanium pedicle screws were interconnected by a plate at the level of lumbar vertebra L6 and inoculated with a methicillin-resistant S.aureus (MRSA) bioluminescent strain. In vivo whole-animal bioluminescence imaging (BLI) and ex vivo bacterial cultures demonstrated a peak in bacterial burden by day 14, when wound dehiscence occurred. Structures suggestive of biofilm, visualized by scanning electron microscopy, were evident up to 56 days following infection. Infection-induced inflammation and bone remodeling were also monitored using 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) and computed tomography (CT). PET imaging signals were noted in the soft tissue and bone surrounding the implanted materials. CT imaging demonstrated marked bone remodeling and a decrease in dense bone at the infection sites. This rabbit model of implant-associated spinal infection provides a valuable preclinical in vivo approach to investigate the pathogenesis of implant-associated spinal infections and to evaluate novel therapeutics.

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