Prevalence of Occult Infections in Posterior Instrumented Spinal Fusion
| Autor: | Frank P. Cammisa, Federico P. Girardi, Michael W. Henry, Darren R. Lebl, Paul D. Kiely, Edward F. DiCarlo, Josh E. Schroeder, Andrew A. Sama, Celeste Abjornson, Tucker C. Callanan |
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| Rok vydání: | 2020 |
| Předmět: |
Reoperation
medicine.medical_specialty medicine.medical_treatment 03 medical and health sciences Propionibacterium acnes 0302 clinical medicine Prevalence medicine Humans Orthopedics and Sports Medicine Bone formation Prospective Studies Prospective cohort study Retrospective Studies 030222 orthopedics biology business.industry Retrospective cohort study biology.organism_classification Occult Surgery Spinal Fusion Spinal fusion Positive culture Neurology (clinical) Aseptic processing business 030217 neurology & neurosurgery |
| Zdroj: | Clinical Spine Surgery: A Spine Publication. 34:25-31 |
| ISSN: | 2380-0186 |
| DOI: | 10.1097/bsd.0000000000001014 |
| Popis: | Study design This is a prospective observational study. Objective The aim of this study is to determine the rate of occult infection after instrumented spine surgery in presumed aseptic patients. Summary of background data The reported incidence rate of delayed/occult infection determined by positive culture swabs after instrumented spine surgery in prospective studies is 0.2%-6.9%. However, this rate may be higher as delayed infections are challenging to diagnose. Fever can be absent and inflammatory markers are often normal. If indolent organisms exist in low concentrations surrounding the instrumentation, these organisms can possibly avoid detection and disrupt bone formation leading to instrumentation loosening, pain generation, and/or failure of a solid fusion. Materials and methods This study included 50 consecutive presumed aseptic patients undergoing a posterior revision requiring removal of instrumentation at least 6 months following their index procedure. Common markers of infection were examined preoperatively. Multiple culture swabs were taken directly from the removed instrumentation and cultured for 14 days. Results Of the 50 patients, 19 (38%) were culture-positive (CP) for bacteria upon removal of their instrumentation, with 14 patients (28%) having ≥2 positive specimens of the same organism. The average length of time between the index procedure and the revision surgery was 4.55 years (range: 0.53-21 y). Polymicrobial infections were found in 26% (5/19) of CP patients. The most prevalent microorganism found was Propionibacterium acnes, in 63% (12/19) of CP patients. There was no significant difference between CP and culture-negative patients regarding preoperative markers for infection, age, or length between index and revision procedures. Conclusions The results of this study indicate a positive culture rate of 38% in presumed aseptic patients who had previously undergone instrumented spine surgery. These results are consistent with other retrospective studies and are >6 times greater than any previous prospective study utilizing culture swabs. Level of evidence Level-III. |
| Databáze: | OpenAIRE |
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