Abstract
Background: Surgical site infection (SSI) is a major complication in spinal instrumentation that is often difficult to treat. The purpose of this study was to identify and determine prognostic indicators for successful treatment of spine instrumentation SSI. Methods: Retrospectively, spine surgery cases were examined on SSI diagnosis. Post-instrumentation SSI patients were categorized as “Successful” if SSI subsided after single debridement. Patients in whom SSI did not subsided and/or required removal of instrumentation were classified as “Challenging”. We investigated the relation of treatment outcomes to patients and treatment factors. Results: A total of 1832 spinal instrumentation cases were recognized with 44 (2.40%) SSI cases. White blood cell count, C-reactive protein (CRP) levels, causative bacteria (i.e., S. Aureus or MRSA), trauma injury, and early-stage antimicrobial agent sensitivity correlated with treatment prognosis. Multivariate analysis highlighted CRP levels and applying early-stage sensitive antibiotics as potential impactful predictive factors for successful treatment. Conclusions: Our results demonstrated that early selection of sensitive antimicrobial agents is critical and emphasizes the potential for early-stage classification methods such as Gram staining. Additionally, S. Aureus and MRSA SSI formed significantly more challenging infections to treat, thus requiring consideration when deciding on instrumentation retention. These factors offer promising aspects for further large-scale studies.
Highlights
Surgical site infection (SSI) is a major complication of concern for spinal instrumentation
Predictive factors for successful SSI resolution have not been well studied. Predictive aspects such as causative bacteria and diabetes have been suggested to be related to prognosis of post-spinal surgery SSI; these factors were found in a general cohort of spinal surgery patients, including cases without instrumentation [15,16]
To enhance comprehension on desirable management of instrumentation SSI, we retrospectively examined cases of spinal surgery at our medical institution comparing successfully treated cases of instrumentation SSI, i.e., single debridement with preservation of the implants leading to SSI clearance compared to instrumentation SSI cases requiring multiple interventions and/or implant removal, in order to identify prognostic factors that correlated with successful treatment
Summary
Surgical site infection (SSI) is a major complication of concern for spinal instrumentation. We previously determined that spine trauma injury and insufficient intraoperative irrigation are risk factors for spinal SSI [1]. Predictive factors for successful SSI resolution have not been well studied. Predictive aspects such as causative bacteria and diabetes have been suggested to be related to prognosis of post-spinal surgery SSI; these factors were found in a general cohort of spinal surgery patients, including cases without instrumentation [15,16]. Aureus and MRSA SSI formed significantly more challenging infections to treat, requiring consideration when deciding on instrumentation retention. These factors offer promising aspects for further large-scale studies
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
