Scoliosis and Spine Tumor Center, Texas Back Institute, Texas Health Presbyterian Hospital, 6020 W. Parker Rd., Ste. 200a, Plano, TX, 75093, USA.
Eur Spine J. 2018 Oct;27(10):2491-2495. doi: 10.1007/s00586-018-5654-5. Epub 2018 Jun 20.
To examine the incidence of occult infection in revision spine surgeries and its correlation with preoperative inflammatory markers.
We retrospectively reviewed all patients who underwent revision spine surgery and hardware removal between 2010 and 2016. Patients who had preoperative clinical signs of infection were excluded. The hardware and surrounding tissue culture results were obtained. The patients' diagnosis and preoperative inflammatory marker (ESR, CRP, and procalcitonin) levels were recorded.
A total of 162 consecutive patients were included in this study. The patients' mean age was 61 years (range 14-88). One hundred and three patients (63.6%) were female. Seventy-two patients (44.4%) had loose hardware and 88 patients (54.3%) had pseudarthrosis. Postoperatively, the hardware and/or surrounding tissue culture was positive in 15 patients (9.3%). The most commonly identified organisms were Propionibacterium acnes (7/15, 46.7%) and Staphylococcus (6/15, 40.0%). The other identified organisms were Pseudomonas aeruginosa (1/15, 6.7%) and Serratia marcescens (1/15, 6.7%). Only four patients with positive cultures had elevated preoperative ESR and CRP levels. Only two patients with positive cultures had elevated preoperative procalcitonin levels. There is no correlation between the patients' preoperative ESR, CRP, procalcitonin levels, and positive culture results (p > 0.05).
Our study shows that occult infections are present in 9.3% of patients who underwent revision spine surgery and hardware removal although they did not have clinical signs of infection. Those commonly used preoperative inflammatory markers such as ESR, CRP, and procalcitonin may not be sensitive enough to detect occult infections in these patients. These slides can be retrieved under Electronic Supplementary Material.
探讨翻修脊柱手术中隐性感染的发生率及其与术前炎症标志物的相关性。
我们回顾性分析了 2010 年至 2016 年间所有接受翻修脊柱手术和内固定物取出的患者。排除术前有感染临床症状的患者。获取内固定物和周围组织的培养结果。记录患者的诊断和术前炎症标志物（ESR、CRP 和降钙素原）水平。
本研究共纳入 162 例连续患者。患者的平均年龄为 61 岁（范围 14-88 岁）。103 例（63.6%）为女性。72 例（44.4%）有松动的内固定物，88 例（54.3%）有假关节。术后，15 例（9.3%）患者的内固定物和/或周围组织培养阳性。最常见的病原体是痤疮丙酸杆菌（7/15，46.7%）和金黄色葡萄球菌（6/15，40.0%）。其他鉴定出的病原体包括铜绿假单胞菌（1/15，6.7%）和粘质沙雷菌（1/15，6.7%）。只有 4 例培养阳性的患者术前 ESR 和 CRP 水平升高。只有 2 例培养阳性的患者术前降钙素原水平升高。患者术前 ESR、CRP 和降钙素原水平与培养阳性结果之间无相关性（p>0.05）。
本研究表明，虽然翻修脊柱手术和内固定物取出的患者没有感染的临床症状，但仍有 9.3%的患者存在隐性感染。ESR、CRP 和降钙素原等常用的术前炎症标志物可能不足以检测这些患者的隐性感染。这些幻灯片可以在电子补充材料中检索。
