Surgical Site Infection After Primary Spinal Fusion Surgery for Adolescent Idiopathic Scoliosis

Rudic, Theodore N.; Althoff, Alyssa D.; Kamalapathy, Pramod; Bachmann, Keith R.

doi:10.1097/brs.0000000000004591

Cited by 7 publications

(5 citation statements)

References 45 publications

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“…In the cohort of 9,801 patients, the infection rate was 0.4% at 7 days, 1.9% at 30 days, and 2.7% at 90 days. Obesity and male sex were identified as independent risk factors for surgical site infection 67 . In a retrospective cohort study analyzing patients who underwent posterior spinal fusion for surgical site infection, Higashi et al compared patients who received vancomycin suspended in fibrin glue in the surgical site before closure with patients who did not.…”

Section: Other Topicsmentioning

confidence: 99%

What’s New in Musculoskeletal Infection

Otero,

Dombrowski,

Brown

et al. 2024

Journal of Bone and Joint Surgery

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Periprosthetic joint infection (PJI) continues to be a devastating complication after total joint arthroplasty (TJA) and remains one of the most common causes for revision TJA. Projections are clear that primary TJA will continue to increase annually and, with it, PJI. In 2022, there was an emphasis on the global economics of PJI management, whereas, in 2023, the literature attempted to provide a more granular look at the financial burden of PJI. Wixted et al. analyzed the direct costs of PJI at a tertiary referral center, including the costs of relevant ancillary services, and demonstrated that the failure of successful reimplantation and the need for additional surgical procedures more than doubled the direct costs of PJI management ($38,865 compared with $79,223) 1 . Additionally, Charalambous et al. assessed cost drivers of 2-stage exchange for PJI treatment and found that age, illicit drug use, the Elixhauser comorbidity index, and number of surgical procedures before reimplantation were all associated with an increased cost of PJI treatment and that failure to clear infection was associated with a >50% increase in total costs at 2 years after treatment 2 . In 2023, the psychosocial impact of PJI was also highlighted. Shichman et al. demonstrated that the sequelae of PJI decreased patientreported quality of life, social satisfaction, and mental health, with approximately 1 of 4 patients regretting their initial decision to undergo primary TJA 3 . Das et al. demonstrated that patients who underwent spacer placement for PJI after TJA had a disproportionately higher incidence of mental health disorders following a surgical procedure compared with aseptic revisions and primary TJA, urging surgeons to consider collaborative management with mental health professionals in the treatment of PJI 4 .Not only are mental health disorders a consequence of PJI, but they are also likely a risk factor. Harmer et al. demonstrated that depression and anxiety were associated with an increased risk of any infection, and specifically with an increased risk of PJI after revision total knee arthroplasty (TKA) 5 .Two-stage exchange continues to be considered the mainstay treatment of PJI, although 1-stage treatment is gaining popularity. In an Australian cost-utility analysis using a Markov model, Okafor et al. found that opting for an index 2-stage revision instead of a 1-stage revision when there is no compelling indication for 2-stage exchange is not likely to be cost-effective 6 . In the United States, most surgeons are utilizing 2-stage exchange, with 75% of American Association of Hip and Knee Surgeons (AAHKS) survey respondents reporting the use of 2-stage exchange rather than 1-stage exchange and with the majority of surgeons handling <20 PJI cases per year 7 . Despite this, the use of single-stage exchange is increasing across the globe, with a single high-volume European center reporting a >30% increase in 1-stage exchange from 2008 to 2021 8 . Fehring et al. reported a 99% reimplantation rate after 2-stage exchange at the...

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Section: Other Topicsmentioning

confidence: 99%

What’s New in Musculoskeletal Infection

Otero,

Dombrowski,

Brown

et al. 2024

Journal of Bone and Joint Surgery

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“…Surgical site infection (SSI) following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) is one of the most frequently reported complications, ranging in incidence from 1%-4% [1]. The most common causative agents for SSI in the AIS population are skin flora such as Staphylococcus aureus and Staphylococcus epidermidis [2].…”

Section: Introductionmentioning

confidence: 99%

“…Abbreviations: GP = gram positive; GN = gram negative; MIC = minimum inhibitory concentration (i.e., the lowest concentration of an antibacterial agent expressed in mg/L [μg/mL] which, under strictly controlled in vitro conditions, completely prevents visible growth of the test strain of an organism [from pathogens 2021]); MSSA = methicillin-sensitive Staphylococcus aureus; Staph. = Staphylococcus 1. Source: Canadian Antimicrobial Resistance Alliance.…”

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confidence: 99%

Dosing Cefazolin for Surgical Site Infection Prophylaxis in Adolescent Idiopathic Scoliosis Surgery: Intermittent Bolus or Continuous Infusion?

Yu,

Dooley,

Woods

et al. 2024

Preprint

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Background: Cefazolin is typically used to minimize the risk of surgical site infection (SSI) following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). Cefazolin dosing recommendations vary and there is limited evidence of the tissue concentrations achieved throughout surgery. Methods: We performed a randomized, controlled, prospective pharmacokinetic pilot study of 12 patients given cefazolin by either intermittent bolus (30mg/kg every 3 hours) or continuous infusion (30 mg/kg bolus followed by 10/mg/kg per hour throughout the surgery) during PSF for AIS. We measured plasma cefazolin concentrations and used a clinical microdialysis technique to measure skeletal muscle and subcutaneous adipose tissue concentrations. Results: Patients were well matched for demographic and perioperative variables. As expected, patients in the infusion group received more cefazolin. While global drug exposure measured as area under the curve was similar in plasma for bolus and infusion dosing, infusion dosing achieved greater cefazolin exposure in subcutaneous and muscle tissue. Using the pharmacodynamic metric of time spent below minimal inhibitory concentration both bolus and infusion dosing performed well. However, when targeting a bactericidal concentration of 32 µg/mL for the typical 6 hour operative time, patients in the bolus group spent a median of 1/5 and 1/3 of below that target in subcutaneous and muscle tissue, respectively. Conclusions: Intraoperative determination of cefazolin tissue concentrations is feasible in PSF for AIS. Both, bolus and infusion dosing of cefazolin achieve concentrations in excess of typical minimal inhibitory concentrations. Infusion dosing appears to more consistently achieve bactericidal concentrations in subcutaneous and muscle tissues.

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“…Surgical site infection (SSI) following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) is one of the most frequently reported complications, ranging in incidence from 1 to 4% [ 6 ]. The most common causative agents for SSI in the AIS population are skin flora such as Staphylococcus aureus and Staphylococcus epidermidis [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Dosing Cefazolin for Surgical Site Infection Prophylaxis in Adolescent Idiopathic Scoliosis Surgery: Intermittent Bolus or Continuous Infusion?—A Pilot Study

Yu,

Dooley,

Woods

et al. 2024

JCM

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Background: Cefazolin may minimize the risk of surgical site infection (SSI) following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). Cefazolin dosing recommendations vary and there is limited evidence for achieved tissue concentrations. Methods: We performed a randomized, controlled, prospective pharmacokinetic pilot study of 12 patients given cefazolin by either intermittent bolus (30 mg/kg every 3 h) or continuous infusion (30 mg/kg bolus followed by 10/mg/kg per hour) during PSF for AIS. Results: Patients were well matched for demographic and perioperative variables. While total drug exposure, measured as area-under-the-curve (AUC), was similar in plasma for bolus and infusion dosing, infusion dosing achieved greater cefazolin exposure in subcutaneous and muscle tissue. Using the pharmacodynamic metric of time spent above minimal inhibitory concentration (MIC), both bolus and infusion dosing performed well. However, when targeting a bactericidal concentration of 32 µg/mL, patients in the bolus group spent a median of 1/5 and 1/3 of the typical 6 h operative time below target in subcutaneous and muscle tissue, respectively. Conclusions: We conclude that intraoperative determination of cefazolin tissue concentrations is feasible and both bolus and infusion dosing of cefazolin achieve concentrations in excess of typical MICs. Infusion dosing appears to more consistently achieve bactericidal concentrations in subcutaneous and muscle tissues.

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Surgical Site Infection After Primary Spinal Fusion Surgery for Adolescent Idiopathic Scoliosis

Cited by 7 publications

References 45 publications

What’s New in Musculoskeletal Infection

What’s New in Musculoskeletal Infection

Dosing Cefazolin for Surgical Site Infection Prophylaxis in Adolescent Idiopathic Scoliosis Surgery: Intermittent Bolus or Continuous Infusion?

Dosing Cefazolin for Surgical Site Infection Prophylaxis in Adolescent Idiopathic Scoliosis Surgery: Intermittent Bolus or Continuous Infusion?—A Pilot Study

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