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. 2018 Aug 31;12(4):490-497.
doi: 10.14444/5060. eCollection 2018 Aug.

An Analysis of Implant Retention and Antibiotic Suppression in Instrumented Spine Infections: A Preliminary Data Set of 67 Patients

Krishn Khanna  1 , Abhinav Janghala  1 , David Sing  1 , Brennan Vail  1 , Grigoriy Arutyunyan  1 , Bobby Tay  1 , Vedat Deviren  1
Affiliations

An Analysis of Implant Retention and Antibiotic Suppression in Instrumented Spine Infections: A Preliminary Data Set of 67 Patients

Krishn Khanna et al. Int J Spine Surg. .

Abstract

Background: It is unclear whether patients can be taken off suppressive antibiotics with infected retained instrumentation. This study aimed to retrospectively analyze the perioperative course and antibiotic regimen that led to the clinical intervention of patients with infected spinal instrumentation.

Methods: Consecutive adult patients with spine instrumentation who suffered surgical site infections (SSI) requiring debridement were retrospectively analyzed. The patients were grouped into 4 cohorts based on their clinical intervention: removal of instrumentation, reinstrumentation, retention of instrumentation with continued antibiotic suppression, and retention of instrumentation with no antibiotic suppression. Patient factors, infection factors, debridement, and antibiosis were compared.

Results: Of the 67 patients with SSI after spine surgery and instrumentation, 19 (28%) had their instrumentation removed, 6 (9%) had their instrumentation exchanged, 25 (37%) had their instrumentation retained and were on antibiotic suppression, and 17 (25%) had their instrumentation retained without any suppression. Those who had their instrumentation removed had a later presentation of their infection averaging 85 days (range 6-280 days) postoperatively. There was an earlier presentation for those who retained their implants, with suppression averaging 19 days (range 9-39) and no suppression averaging 29 days (range 6-90 days) post operatively (P < .001).

Conclusions: None of the patients with retained instrumentation without suppression had recurrence of infections after long-term follow-up. Lifelong antibiotic suppression may not be required with SSI that present early after early aggressive debridement. Patients with infections detected later are difficult to treat without removal of their original instrumentation.

Clinical relevance: This study presents the outcomes of surgical and antibiotic factors in patients with infected spinal instrumentation.

Keywords: antibiotic suppression; spinal instrumentation; surgical site infection.

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Conflict of interest statement

Disclosures and COI: All authors declare that they have no conflict of interest with the contents of this manuscript. UCSF IRB Approval: 15-16807.

Figures

Figure 1
Figure 1
Graphical representation of the clinical intervention relative to the number of instrumented levels.
Figure 2
Figure 2
Graphical representation of the probability of retaining instrumentation with each successive surgical debridement.
See this image and copyright information in PMC

References

    1. Wenzel RP. Health care-associated infections: major issues in the early years of the 21st century. Clin Infect Dis. 2007;45(suppl 1):S85–S88. doi: 10.1086/518136. - DOI - PubMed
    1. Anderson DJ. Surgical site infections. Infect Dis Clin North Am. 2011;25(1):135–153. doi: 10.1016/j.idc.2010.11.004. - DOI - PubMed
    1. McGirt MJ, Godil SS. Reduction of surgical site infection in spine surgery: an opportunity for quality improvement and cost reduction. Spine J. 2013;13(9):1030–1031. doi: 10.1016/j.spinee.2013.06.003. - DOI - PubMed
    1. Broex ECJ, van Asselt ADI, Bruggeman CA, van Tiel FH. Surgical site infections: how high are the costs? J Hosp Infect. 2009;72(3):193–201. doi: 10.1016/j.jhin.2009.03.020. - DOI - PubMed
    1. Petilon JM, Glassman SD, Dimar JR, Carreon LY. Clinical outcomes after lumbar fusion complicated by deep wound infection. Spine (Phila Pa 1976) 2012;37(16):1370–1374. doi: 10.1097/BRS.0b013e31824a4d93. - DOI - PubMed