Palmowski Yannick, Bürger Justus, Kienzle Arne, Trampuz Andrej
Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery, Berlin, Germany.
Laboratory of Adaptive and Regenerative Biology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA.
J Spine Surg. 2020 Dec;6(4):785-792. doi: 10.21037/jss-20-456.
Postoperative spinal implant infection (PSII) is a serious complication after spinal surgery. It is associated with increased morbidity and mortality for affected patients as well as significant costs for the healthcare system. Due to the formation of biofilm on foreign material, both diagnosis and treatment of PSII can pose a considerable challenge. Modern treatment protocols allow efficient eradication and good clinical outcomes in the majority of patients. In this article, we review the current antibiotic treatment concepts for PSII including the correct choice of antibiotics and their combination. In cases of late-onset PSII where the implants can be removed, two weeks of intravenous (IV) antibiotics followed by 4 weeks of oral antibiotics seem appropriate. If the implant needs to be retained, a 2-week IV antibiotic treatment should be followed by 10 weeks of oral antibiotic therapy with biofilm activity or, in case of problematic pathogens, a long-term suppression therapy. Initial empiric antibiotic therapy should cover staphylococci, streptococci, enterococci and Gram-negative bacilli as the most common pathogens. Antibiotic adjustments according to the type of pathogen and its antimicrobial susceptibility are essential for successful eradication of infection.
术后脊柱植入物感染（PSII）是脊柱手术后的一种严重并发症。它会增加受影响患者的发病率和死亡率，同时给医疗系统带来巨大成本。由于异物上会形成生物膜，PSII的诊断和治疗都可能构成相当大的挑战。现代治疗方案能使大多数患者实现有效根除感染并取得良好的临床效果。在本文中，我们回顾了当前针对PSII的抗生素治疗理念，包括抗生素的正确选择及其联合使用。对于植入物可移除的迟发性PSII病例，静脉注射（IV）抗生素治疗两周后再口服抗生素治疗四周似乎是合适的。如果需要保留植入物，应在静脉注射抗生素治疗两周后，采用具有生物膜活性的口服抗生素治疗十周，或者在病原体有问题的情况下，进行长期抑制治疗。初始经验性抗生素治疗应覆盖葡萄球菌、链球菌、肠球菌和革兰氏阴性杆菌等最常见的病原体。根据病原体类型及其抗菌药敏情况调整抗生素对于成功根除感染至关重要。
