Variables associated with remission in spinal surgical site infections

Abstract

Background: There is few medical literature regarding factors associated with remission after surgical and medical treatment of postoperative spine infections.Methods: Single-centre case-control study [2007][2008][2009][2010][2011][2012][2013][2014]. Cluster-controlled Cox regression model with emphasis on surgical and antibiotic-related parameters.Results: Overall, we found 66 episodes in 48 patients (49 episodes with metalwork) who had a median follow-up of 2.6 years (range, 0.5 to 6.8 years). The patients had a median of two surgical debridements.The median duration of antibiotic therapy was 8 weeks, of which 2 weeks parenteral. Clinical recurrence after treatment was noted in 13 episodes (20%), after a median interval of 2 months. In 53 cases (80%), the episodes were considered as in remission. By multivariate analyses, no variable was associated with remission. Conclusions:In patients with post-operative spine infections, remission is achieved in 80%. The number of surgical debridement or duration of antibiotic therapy shows no association with recurrence, suggesting that individual risk factors might be more important than the duration of antibiotic administration.

Protocol of a short post-surgical antibiotic therapy in spine infections - prospective, randomized, unblinded, non-inferiority trials(SASI trials)

“…Surgical site infections are feared complications of spine surgery of which the volume is expected to increase every year; worldwide [1]. Likewise, community-acquired spine infections (SI) are associated with enhanced morbidity; costs and prolonged hospital stay for the patients [1].…”

“…Surgical site infections are feared complications of spine surgery of which the volume is expected to increase every year; worldwide [1]. Likewise, community-acquired spine infections (SI) are associated with enhanced morbidity; costs and prolonged hospital stay for the patients [1]. Most scientific papers are rather interested in the epidemiology of SI and risk factors for surgical site infections after spine surgery [2], occurring at 1% to 3% [2][3][4], rather than the modalities and outcomes of their treatment.…”

“…So far, literature on antibiotic regimens in SI is very sparse and strongly eminence-based (instead of basing on evidence). Most experts recommend a minimum length of (intravenous) antibiotic courses of two to four weeks, often followed by prolonged oral antimicrobial regimens in case of infected osteosynthesis material that was kept in place [1]. Comparative data supporting these individual therapeutic recommendations are lacking.…”

“…In 53 cases (80%), the episodes were in complete remission. In clustercontrolled multivariate Cox regression analysis adjusting for the case-mix, the duration of postsurgical antibiotic therapy was completely indecisive regarding the "remission of infection" or "mechanical sequels" [1]. Especially, we the following clinically important variables were all unrelated to remission: number of surgical interventions (hazard ratio [HR] 0.9, 95% confidence interval 0.8-1.1); infection due to Staphylococcus aureus (HR 0.9; 0.8-1.1), local antibiotic therapy (HR 1.2; 0.6-2.4), and, duration of total (HR 1.0; 0.99-1.01) (or just parenteral) (HR 1.0; 0.99-1.01) antibiotic use [1].…”

Surgical site infections in spinal neurosurgery

“…[45] доказана эф-фективность применения комплексного метода лечения ИОХВ у пациентов после декомпрес-сивно-стабилизирующих оперативных вмеша-тельств на позвоночнике. Суть метода заклю-чалась в следующем.…”