Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA.
Spine (Phila Pa 1976). 2010 Jun 1;35(13):1323-8. doi: 10.1097/BRS.0b013e3181bcde61.
Descriptive, retrospective cohort analysis.
To evaluate the presentation, etiology, and treatment of surgical site infections (SSI) after spinal surgery.
SSI after spine surgery is frequently seen. Small case control studies have been published reporting the results of treatment options of SSI. We performed this study to identify the most common clinical and laboratory presentation of a SSI, the most frequently seen infective organism, and evaluate the effectiveness of current treatment.
All patients who underwent spinal surgery at our institution for diagnosis other than infection between June 1996 and December 2005 (N=3174) were reviewed. All cases of SSI were identified. Patient and operative characteristics were reviewed. Infection type (deep or superficial), treatment course, laboratory and culture results were abstracted.
A total of 132 cases of SSI (84 deep and 48 superficial) were identified. About 72.7% of the SSI were detected as outpatients an average 28.7 days (deep, 29.9; superficial, 25.2) after the index procedure. Wound drainage was the most common complaint (68.2%). C-reactive protein level was elevated in 98.0%, erythrocyte sedimentation rate was elevated in 94.4%, but only 48.6% had elevated white blood cell count. Staphylococcus aureus was isolated in 72.6% of deep and 85.7% of superficial positive cultures. Seventy-six percent of deep SSI could be treated with a single debridement to clear the SSI. Instrumentation was retained or primarily exchanged if loose in all cases. Around 72.9% of superficial SSI were treated without formal debridement in the operating room. Antibiotic treatment was longer in deep SSI (40.8 vs. 19.6 days).
Deep SSI following spinal surgery was effectively treated with single stage debridement and intravenous antibiotics. Superficial SSI could be treated effectively with local wound care and oral antibiotic therapy.
描述性、回顾性队列分析。
评估脊柱手术后手术部位感染（SSI）的表现、病因和治疗方法。
脊柱手术后发生 SSI 较为常见。已经发表了一些小病例对照研究报告了 SSI 治疗选择的结果。我们进行这项研究是为了确定 SSI 最常见的临床和实验室表现、最常见的感染病原体，并评估当前治疗方法的效果。
回顾 1996 年 6 月至 2005 年 12 月期间在我院因非感染性疾病接受脊柱手术的所有患者（N=3174）。所有 SSI 病例均被识别。回顾患者和手术特点。提取感染类型（深部或浅部）、治疗过程、实验室和培养结果。
共发现 132 例 SSI（84 例深部和 48 例浅部）。约 72.7%的 SSI 在指数手术后平均 28.7 天（深部，29.9；浅部，25.2）被发现为门诊患者。伤口引流是最常见的主诉（68.2%）。98.0%的 C-反应蛋白水平升高，94.4%的红细胞沉降率升高，但只有 48.6%的白细胞计数升高。金黄色葡萄球菌在 72.6%的深部和 85.7%的浅部阳性培养物中分离出来。76%的深部 SSI 可通过单次清创术清除 SSI。所有病例中，如果器械松动，则保留或主要更换。约 72.9%的浅部 SSI 无需在手术室进行正式清创即可得到治疗。深部 SSI 的抗生素治疗时间更长（40.8 天 vs. 19.6 天）。
脊柱手术后深部 SSI 经单阶段清创术和静脉内抗生素治疗有效。浅部 SSI 可通过局部伤口护理和口服抗生素治疗有效治疗。
