The Management and Outcome of Spinal Implant-related Infections in Pediatric Patients

Abstract

Infection related to spinal instrumentation procedures can be managed medically with long-term antibiotic therapy. Careful monitoring for not only efficacy but also adverse drug events is advised. Further research is needed to determine the optimal duration of antibiotics for spinal implant-related infections.

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

“…The pooled average SSI rate was calculated to be 1.6% (median, 2.8%; range, 0.2%–18.3%) based on 64 cohorts comprising a total of 212,639 patients. Patients who underwent instrumented spinal fusion procedures were evaluated for SSIs in 35 identified studies [6,12,25,28,35,37,39,48,50,61,67,74,77,78,84,85,90,93,97,98,101,112,121,122,126,127,132,134,135,137,148,154,156,160,174]. The pooled average SSI rate was calculated to be 3.8% (median, 4.2%; range, 0.4%–20%) based on 39 cohorts with a total of 28,628 patients.…”

“…A total of 39 studies evaluating S. aureus SSI rates among patients who underwent spine operations of interest were included in this study (Table 1A) [6,7,10–15,32,37,45,47,48,52,53,62,77,84,90,91,101,103,111–113,117,122,126,129,132,137,138,140,146,155,160,164,167,173]. The pooled average S. aureus SSI rate was calculated to be 1% (median, 2%; range, 0.02%–10%) based on 42 cohorts evaluating a total of 112,135 patients.…”

“…On the basis of nine studies with nine cohorts consisting of a total of 9,604 patients who underwent spinal fusion, the calculated pooled average rate was 1.8% (median, 2.6%; range, 1.1%–8.3%) [14,15,52,62,103,113,146,164,173]. According to 13 studies consisting of 14 cohorts with a total of 14,835 patients who underwent instrumented spinal fusion, the calculated pooled average rate was 1.4% (median, 2%; range, 0.1%–10%) [6,37,48,77,84,90,101,112,122,126,132,137,160]. The pooled average contribution of S. aureus infections to spinal SSIs was calculated to be 49.3% (median, 50%; range, 16.7%–100%; 2,272 SSIs) [6,7,10–15,32,37,45,47,48,52,53,62,77,84,90,91,101,103,111–113,117,122,126,129,132,137,138,140,146,155,160,164,167,173].…”

“…There were 30 studies that assessed the proportion of S. aureus SSIs after spine operations of interest that were attributed to MRSA (Table 1B) [6,10–14,22,25,32,37,45,53,62,84,90,111,113,117,122,126,129,137,138,146,155,160,164,167,175,176]. The pooled average proportion of S. aureus SSIs attributable to MRSA was calculated to be 37.9% based on 32 cohorts with a total of 1,071 patients experiencing S. aureus SSIs (median, 42.5%).…”

“…On the basis of six studies evaluating patients who underwent spinal fusion, this proportion was calculated to be 24.6% among a total of 175 patients experiencing S. aureus SSIs (median, 29.4%) [14,62,113,146,164,175]. Furthermore, according to 10 studies with patients who underwent instrumented spinal fusion, this proportion was calculated to be 35.5% among a total of 166 patients experiencing S. aureus SSIs (median, 38.8%) [6,25,37,84,90,122,126,137,160,176]. …”