Is Propionibacterium acnes becoming the most common bacteria in delayed infections following adolescent idiopathic scoliosis surgery?

STUDY DESIGN

Retrospective review of hospital charts.

OBJECTIVE

(1) To determine the microbiological profile of patients with surgical site infections following posterior spinal fusion surgery (PSF) for Adolescent Idiopathic scoliosis (AIS). (2) To study the treatment outcome of patients with surgical site infections (SSI) following surgery for AIS. (3) To identify the key differences in presentation and management of acute and delayed SSI following AIS surgery. There has been increasing evidence of the role of P. acnes in deep surgical site infections. Literature related to this is abundant in relation to shoulder arthroplasty; however, it is sparse in relation to spine surgery.

METHODS

We conducted a retrospective review of all patients treated for AIS during a 5-year period (2010-2014) at our institution, with a minimum of 2-year follow-up after the index surgery. Patients with a postoperative infection following their index surgery were included. Charts of AIS patients with post-op infections were reviewed for details of the index surgery, time to presentation of the infection, presenting signs/symptoms, microbiology details, details of surgical and antibiotic treatment, and outcomes.

RESULTS

Nine (2.8%) post-op infections were identified out of 315 cases for AIS during this period. Seven (2.2%) involved P. acnes. Two (0.6%) involved MSSA. The average time for cultures to show growth was 6.1 days (range 5-8 days) in P. acnes group and 2-3 days in MSSA group. Patients with P. acnes infections were treated with implant removal, debridement and antibiotics. All patients achieved solid fusion except two patients from the P. acnes group had pseudoarthrosis and had to undergo revision fusion.

CONCLUSION

Propionibacterium acnes was the single most common bacteria isolated from delayed surgical site infection following PSF in AIS patients. Optimal treatment consists of debridement, implant removal and antibiotics. These patients have high incidence of pseudoarthrosis.

LEVEL OF EVIDENCE

Level IV.