2021 Young Investigator Award Winner: Anatomic Gradients in the Microbiology of Spinal Fusion Surgical Site Infection and Resistance to Surgical Antimicrobial Prophylaxis

Autor: Dustin R. Long, Ronald Pergamit, Celeste Tavolaro, Rajiv Saigal, John B. Lynch, Jeannie D. Chan, Chloe Bryson-Cahn
Rok vydání: 2020
Předmět:
Male
Epidemiology
medicine.medical_treatment
Awards and Prizes
microbiome
medicine.disease_cause
0302 clinical medicine
Postoperative Complications
Infection control
Orthopedics and Sports Medicine
Antibiotic prophylaxis
030222 orthopedics
Middle Aged
gram-negative bacteria
Anti-Bacterial Agents
Infectious Diseases
surgical antibiotic prophylaxis
Spinal fusion
wound infection
Female
Infection
Methicillin-Resistant Staphylococcus aureus
medicine.medical_specialty
Clinical Sciences
Biomedical Engineering
Microbiology
Article
Vaccine Related
03 medical and health sciences
Clinical Research
healthcare-associated infection
Biodefense
medicine
Humans
Surgical Wound Infection
antimicrobial resistance
Aged
Retrospective Studies
business.industry
Prevention
Retrospective cohort study
surgical site infection
Antibiotic Prophylaxis
Methicillin-resistant Staphylococcus aureus
Spine
Emerging Infectious Diseases
Good Health and Well Being
Orthopedics
Spinal Fusion
Methicillin Resistance
Neurology (clinical)
Complication
business
030217 neurology & neurosurgery
Lumbosacral joint
Zdroj: Spine (Phila Pa 1976)
Spine, vol 46, iss 3
ISSN: 1528-1159
Popis: STUDY DESIGN Retrospective hospital-registry study. OBJECTIVE To characterize the microbial epidemiology of surgical site infection (SSI) in spinal fusion surgery and the burden of resistance to standard surgical antibiotic prophylaxis. SUMMARY OF BACKGROUND DATA SSI persists as a leading complication of spinal fusion surgery despite the growth of enhanced recovery programs and improvements in other measures of surgical quality. Improved understandings of SSI microbiology and common mechanisms of failure for current prevention strategies are required to inform the development of novel approaches to prevention relevant to modern surgical practice. METHODS Spinal fusion cases performed at a single referral center between January 2011 and June 2019 were reviewed and SSI cases meeting National Healthcare Safety Network criteria were identified. Using microbiologic and procedural data from each case, we analyzed the anatomic distribution of pathogens, their differential time to presentation, and correlation with methicillin-resistant Staphylococcus aureus screening results. Susceptibility of isolates cultured from each infection were compared with the spectrum of surgical antibiotic prophylaxis administered during the index procedure on a per-case basis. Susceptibility to alternate prophylactic agents was also modeled. RESULTS Among 6727 cases, 351 infections occurred within 90 days. An anatomic gradient in the microbiology of SSI was observed across the length of the back, transitioning from cutaneous (gram-positive) flora in the cervical spine to enteric (gram-negative/anaerobic) flora in the lumbosacral region (correlation coefficient 0.94, P
Databáze: OpenAIRE
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