Maruo Keishi, Berven Sigurd H
Department of Orthopedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan,
J Orthop Sci. 2014 May;19(3):398-404. doi: 10.1007/s00776-014-0545-z. Epub 2014 Feb 8.
Surgical site infection (SSI) is an important complication after spine surgery. The management of SSI is characterized by significant variability, and there is little guidance regarding an evidence-based approach. The objective of this study was to identify risk factors associated with treatment failure of SSI after spine surgery.
A total of 225 consecutive patients with SSI after spine surgery between July 2005 and July 2010 were studied retrospectively. Patients were treated with aggressive surgical debridement and prolonged antibiotic therapy. Outcome and risk factors were analyzed in 197 patients having 1 year of follow-up. Treatment success was defined as resolution within 90 days.
A total of 126 (76 %) cases were treated with retention of implants. Forty-three (22 %) cases had treatment failure with five (2.5 %) cases resulting in death. Lower rates of treatment success were observed with late infection (38 %), fusion with fixation to the ilium (67 %), Propionibacterium acnes (43 %), poly microbial infection (68 %), >6 operated spinal levels (67 %), and instrumented cases (73 %). Higher rates of early resolution were observed with superficial infection (93 %), methicillin-sensitive Staphylococcus aureus (95 %), and <3 operated spinal levels (88 %). Multivariate logistic regression revealed late infection was the most significant independent risk factor associated with treatment failure. Superficial infection and methicillin-sensitive Staphylococcus aureus were predictors of early resolution.
Postoperative spine infections were treated with aggressive surgical debridement and antibiotic therapy. High rates of treatment failure occurred in cases with late infection, long instrumented fusions, polymicrobial infections, and Propionibacterium acnes. Removal of implants and direct or staged re-implantation may be a useful strategy in cases with high risk of treatment failure.
手术部位感染（SSI）是脊柱手术后的一种重要并发症。SSI的管理具有显著的变异性，并且关于循证方法的指导很少。本研究的目的是确定脊柱手术后与SSI治疗失败相关的危险因素。
回顾性研究了2005年7月至2010年7月期间连续的225例脊柱手术后发生SSI的患者。患者接受了积极的手术清创和延长的抗生素治疗。对197例随访1年的患者的结局和危险因素进行了分析。治疗成功定义为90天内症状缓解。
共有126例（76%）病例采用保留植入物的治疗方法。43例（22%）病例治疗失败，其中5例（2.5%）导致死亡。晚期感染（38%）、与髂骨固定融合（67%）、痤疮丙酸杆菌感染（43%）、多微生物感染（68%）、手术节段>6个（67%）以及使用内固定的病例（73%）的治疗成功率较低。浅表感染（93%）、对甲氧西林敏感的金黄色葡萄球菌感染（95%）以及手术节段<3个（88%）的病例早期缓解率较高。多因素逻辑回归显示，晚期感染是与治疗失败相关的最显著独立危险因素。浅表感染和对甲氧西林敏感的金黄色葡萄球菌是早期缓解的预测因素。
术后脊柱感染采用积极的手术清创和抗生素治疗。晚期感染、长节段内固定融合、多微生物感染以及痤疮丙酸杆菌感染的病例治疗失败率较高。对于治疗失败风险高的病例，取出植入物并直接或分期重新植入可能是一种有用的策略。
