Infectious Diseases Department, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.
Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain.
J Antimicrob Chemother. 2021 Mar 12;76(4):1085-1093. doi: 10.1093/jac/dkaa548.
Available information about infection after spine instrumentation (IASI) and its management are scarce. We aimed to analyse DAIR (debridement, antibiotics and implant retention) prognosis and evaluate effectiveness of short antibiotic courses on early forms.
Multicentre retrospective study of patients with IASI managed surgically (January 2010-December 2016). Risk factors for failure were analysed by multivariate Cox regression and differences between short and long antibiotic treatment were evaluated with a propensity score-matched analysis.
Of the 411 IASI cases, 300 (73%) presented in the first month after surgery, 48 in the second month, 22 in the third and 41 thereafter. Infections within the first 2 months (early cases) occurred mainly to older patients, with local inflammatory signs and predominance of Enterobacteriaceae, unlike those in the later periods. When managed with DAIR, prognosis of early cases was better than later ones (failure rate 10.4% versus 26.1%, respectively; P = 0.02). Risk factors for DAIR failure in early cases were female sex, Charlson Score, large fusions (>6 levels) and polymicrobial infections (adjusted HRs of 2.4, 1.3, 2.6 and 2.26, respectively). Propensity score matching proved shorter courses of antibiotics (4-6 weeks) as effective as longer courses (failure rates 11.4% and 10.5%, respectively; P = 0.870).
IASIs within the first 2 months could be managed effectively with DAIR and shorter antibiotic courses. Clinicians should be cautious when faced with patients with comorbidities, large fusions and/or polymicrobial infections.
目前有关脊柱内固定术后感染（IASI）及其处理的信息有限。本研究旨在分析清创、灌洗、抗生素保留（DAIR）治疗的预后，并评估短期抗生素疗程对早期 IASI 的有效性。
这是一项多中心回顾性研究，纳入了 2010 年 1 月至 2016 年 12 月间接受手术治疗的 IASI 患者。采用多变量 Cox 回归分析失败的危险因素，并通过倾向评分匹配分析评估短期和长期抗生素治疗之间的差异。
411 例 IASI 患者中，300 例（73%）发生在术后 1 个月内，48 例发生在术后 2 个月内，22 例发生在术后 3 个月内，41 例发生在术后 3 个月后。前 2 个月（早期病例）的感染主要发生在老年患者中，存在局部炎症表现，肠杆菌科细菌占优势，而晚期病例则不同。采用 DAIR 治疗时，早期病例的预后优于晚期病例（失败率分别为 10.4%和 26.1%；P=0.02）。早期病例 DAIR 治疗失败的危险因素包括女性、Charlson 评分、大融合（>6 个节段）和混合感染（调整后的 HR 分别为 2.4、1.3、2.6 和 2.26）。倾向评分匹配证实，4-6 周的短疗程抗生素与长疗程抗生素（失败率分别为 11.4%和 10.5%；P=0.870）同样有效。
前 2 个月内的 IASI 可采用 DAIR 治疗和较短的抗生素疗程有效治疗。当面对合并症、大融合和/或混合感染的患者时，临床医生应保持警惕。
