Yoon Jang W, Wanderman Nathan R, Kerezoudis Panagiotis, Alvi Mohammed Ali, De Biase Gaetano, Akinduro Oluwaseun O, Berbari Elie F, Bydon Mohamad, Freedman Brett A
Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA.
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
World Neurosurg. 2019 Mar;123:e330-e337. doi: 10.1016/j.wneu.2018.11.169. Epub 2018 Nov 27.
Gram-negative surgical site infections (SSI) following spine surgery are becoming increasingly more common owing to a broad perioperative antibiotic usage targeting gram-positive organisms. Enterobacter species have been reported to be the most common gram-negative bacteria following spine surgery.
We queried our institutional database for Enterobacter SSIs after spine surgery at a single institution from 2009-2016. Relevant demographic, clinical, and operative variables were collected. We compared this cohort to patients who had non-Enterobacter SSI during the same period.
Enterobacter species were isolated in 16 patients (9 males) diagnosed with SSI after undergoing spine surgery. This group represented 0.2% of all spine cases and 14.5% of all spinal SSIs. Seven patients (43.8%) required multiple irrigations and debridements (I&Ds) (range: 2-8), whereas only 17 of 94 patients (18.1%) with non-Enterobacter SSI required multiple I&Ds (range: 2-5, P = 0.043). Those infected with Enterobacter were associated with higher BMI (37.6 ± 12.7 vs. 31.7 ± 8, P = 0.036), earlier wound dehiscence (14.8 vs. 24.6 days, P = 0.01), polymicrobial infections (37.5% vs. 10.6%, P = 0.012), and longer length of stay (18 days [9.5-31.5] vs. 5 days [3-8], P = 0.01) when compared to non-Enterobacter SSI cohort. At an average of 24.2 months follow-up, all 15 surviving patients were infection free with no further revision surgeries needed.
Enterobacter SSI cases were associated with higher BMI, earlier wound breakdown, polymicrobial infection and longer length of stay. Nevertheless, with vigilant surveillance and timely I&Ds, these challenging infections can be treated successfully with original implant retention in almost all cases.
由于围手术期广泛使用针对革兰氏阳性菌的抗生素，脊柱手术后革兰氏阴性菌手术部位感染（SSI）越来越常见。据报道，肠杆菌属是脊柱手术后最常见的革兰氏阴性菌。
我们查询了某单一机构2009年至2016年脊柱手术后发生肠杆菌属SSI的机构数据库。收集了相关的人口统计学、临床和手术变量。我们将该队列与同期发生非肠杆菌属SSI的患者进行了比较。
16例（9例男性）脊柱手术后被诊断为SSI的患者分离出肠杆菌属。该组占所有脊柱病例的0.2%，占所有脊柱SSI的14.5%。7例（43.8%）患者需要多次冲洗和清创（I&D）（范围：2 - 8次），而94例非肠杆菌属SSI患者中只有17例（18.1%）需要多次I&D（范围：2 - 5次，P = 0.043）。与非肠杆菌属SSI队列相比，感染肠杆菌属的患者BMI更高（37.6±12.7 vs. 31.7±8，P = 0.036），伤口裂开更早（14.8天 vs. 24.6天，P = 0.01），多微生物感染更多（37.5% vs. 10.6%，P = 0.012），住院时间更长（18天[9.5 - 31.5] vs. 5天[3 - 8]，P = 0.01）。平均随访24.2个月时，所有15例存活患者均无感染，无需进一步翻修手术。
肠杆菌属SSI病例与更高的BMI、更早的伤口破裂、多微生物感染和更长的住院时间相关。然而，通过 vigilant surveillance（此处原文可能有误，推测为vigilant surveillance，意为“严密监测”）和及时的I&D，在几乎所有情况下，这些具有挑战性的感染都可以通过保留原植入物成功治疗。
