Bacterial Contamination in Osteosynthesis Material Removed after 6/8 Months Postoperative

Abstract

IntroductionThe aim of this paper is to describe the results obtained in 26 patients, which their osteosynthesis material was removed after 6–8 months of their first surgery following the surgery standards of temporary fixation of our service. They were operated between November 2014 and July 2015 in our department of Orthopedics and Traumatology in Corporación Medica of General San Martin in Buenos Aires, Argentina. All the patients were operated by the same surgeon, the same assistants and the same surgical scrub nurse. In all cases we used the same technique, which consists in a lozenge on the previous surgical wound and the removal of the polyaxial pedicle screws and the corresponding bars. After the removal of the material we proceeded to send one screw of each patient for cultivation and subsequent antibiogram. The results were surprising because in three cases our bacteriology service found a germ growth. None of the 26 patients studied presented during the 6–8 months that the osteosynthesis material was placed any signs or symptoms of infection. Material and Methods26 patients, 18 men and 8 women were evaluated in which the osteosynthesis material was removed according to the established protocols. All patients were studied by MRI and Rx and treated by the same surgeon, assistants and scrub nurse. In all cases the cultivation and antibiogram was performed by the same laboratory and the preliminary results were always between 72–96 hour. Surgical technique: Posterior approach, lozenge on the previous surgical wound and the subsequent removal of the polyaxial pedicle screws and the corresponding bars. ResultsIn 3 of the 26 cases sent for cultivation and antibiogram we found positive samples. In one case the cultivation was for Pseudomonas aeruginosa and the remaining two cases were positive for Staphylococcus aureus. The rest of the samples sent were negative. None of the patients had postoperative complications. The entire surgical wounds healed normally, without any secretions or phlogosis. No patients required antibiotic therapy in the immediate postoperative nor in the following months. The following of them was held up to 6 months post surgery. ConclusionAfter an exhaustive study of each of our patients we conclude that in most cases where a postoperative infection occurs it is more due to patient factors such as nutritional status thereof; which keeps a close relationship with the immunological response of the patient; malnutrition or immunosuppression due to diabetes mellitus, alcoholism, chemotherapy agents or tumors than to factors which depend directly to the surgeon like the skin preparation or the operating room environment factors. Due to the type of sample sent; even though we took the necessary precautions; we cannot dismiss skin contamination.