Beydoun Nour, Tandon Sonia, Krengel Sonia, Johnson Eric, Palacio Bedoya Federico, Moore Michael, Refai Daniel, Rouphael Nadine
Department of Internal Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
The Hope Clinic, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA.
Open Forum Infect Dis. 2020 Jun 25;7(7):ofaa253. doi: 10.1093/ofid/ofaa253. eCollection 2020 Jul.
One percent to 8% of patients undergoing spinal instrumentation surgeries develop infections. There is no consensus on the medical and surgical management of these infections.
We conducted a retrospective chart review based on and Common Procedural Terminology codes relevant to spinal infections with hardware within Emory Healthcare over a 10-year period. Extracted data included patient demographics, clinical presentation, laboratory and microbiologic results, and surgical and medical management including choice and duration of suppressive therapy. Multivariable logistic regression was used to assess the association of length of use of suppressive antibiotics with treatment success and to identify predictors of use of suppressive antibiotics.
Of 869 records, 124 met inclusion criteria. Fifty patients (40.3%) had an infection that occurred after hardware placement, mostly within 3 months postsurgery, while the remainder had vertebral osteomyelitis that required hardware placement. After initial intravenous antibiotic treatment for ≥4 weeks, 72 patients (64.5%) were given suppressive antibiotics. The overall treatment success rate was 78.2%. In spinal infections involving hardware with gram-negative rods, patients were less likely to receive suppressive antibiotics, less likely to have hardware removed, and less likely to have treatment success compared with patients with infections with species.
Management of spinal infections involving hardware should be tailored to the timing of onset of infection and causative organism. Further studies are needed to determine best management practices, particularly for gram-negative rod infections where the role of further suppressive antibiotics and hardware removal may be warranted.
接受脊柱内固定手术的患者中有1%至8%会发生感染。对于这些感染的药物和手术治疗尚无共识。
我们基于与埃默里医疗系统内脊柱硬件感染相关的国际疾病分类和通用程序术语代码进行了一项回顾性图表审查，为期10年。提取的数据包括患者人口统计学信息、临床表现、实验室和微生物学结果，以及手术和药物治疗，包括抑制性治疗的选择和持续时间。使用多变量逻辑回归来评估抑制性抗生素使用时长与治疗成功之间的关联，并确定抑制性抗生素使用的预测因素。
在869份记录中，有124份符合纳入标准。50名患者（40.3%）在硬件植入后发生感染，大多在术后3个月内，其余患者患有需要植入硬件的椎体骨髓炎。在初始静脉抗生素治疗≥4周后，72名患者（64.5%）接受了抑制性抗生素治疗。总体治疗成功率为78.2%。在涉及革兰氏阴性杆菌硬件的脊柱感染中，与感染其他菌种的患者相比，患者接受抑制性抗生素治疗的可能性较小，硬件移除的可能性较小，治疗成功的可能性也较小。
涉及硬件的脊柱感染的管理应根据感染发生时间和病原体进行调整。需要进一步研究以确定最佳管理实践，特别是对于革兰氏阴性杆菌感染，可能需要进一步使用抑制性抗生素和移除硬件。
