de la Hera Borja, Sánchez-Mariscal Felisa, Gómez-Rice Alejandro, Vázquez-Vecilla Iria, Zúñiga Lorenzo, Ruano-Soriano Esther
Department of Orthopedic Surgery, Getafe University Hospital, Madrid, Spain.
Complutense University, Madrid, Spain.
Int J Spine Surg. 2021 Feb;15(1):144-152. doi: 10.14444/8019. Epub 2021 Feb 12.
Deep surgical-site infection following thoracolumbar instrumented spinal surgery (DSITIS) is a major complication in spine surgery and its impact on long-term morbidity and mortality is yet to be determined. This article describes the characteristics and evolution of DSITIS in our center over a period of 25 years.
This single-center, retrospective cohort study included patients diagnosed with DSITIS between January 1992 and December 2016 and with a minimum follow-up after infection diagnosis of 1 year. The Infectious Diseases Society of America criteria and/or Centers for Disease Control and Prevention criteria were used to define DSITIS. Patient data (epidemiological and health status), surgical data, infection characteristics and presentation, isolated microorganisms, required surgical debridements, implant removal, and major complications linked to infection were evaluated.
A total of 174 patients (106 females) were included in the analysis. Mean follow-up after infection diagnosis was 40 months (56 patients with over 5 years follow-up). Adolescent idiopathic scoliosis, adult deformity, and degenerative lumbar stenosis were the most frequent etiologies for primary surgery. Presentation of infection was considered early (0-3 months since first surgery) in 59.2% of the cases, delayed (3-24 months) in 11.5%, and late (more than 24 months) in 29.3%. All patients were treated by surgical debridement. More than 1 surgical debridement was necessary in 20.7% of cases. Implants were removed in 46.6% of the patients (72.83% in the first surgical debridement). Most frequently isolated microorganisms were spp, Enterobacteriaceae, and . Major complications appeared in 14.3% of the patients, and over 80% of them required major surgeries to resolve those complications.
Late DSITIS is more frequent than previously reported. In DSITIS culprits, spp, Enterobacteriaceae, and predominate. DSITIS produce a high rate of major complications that usually require major surgery for treatment.
胸腰椎器械辅助脊柱手术后深部手术部位感染（DSITIS）是脊柱手术中的一种主要并发症，其对长期发病率和死亡率的影响尚待确定。本文描述了25年间我院中心DSITIS的特征及演变情况。
这项单中心回顾性队列研究纳入了1992年1月至2016年12月期间诊断为DSITIS且感染诊断后至少随访1年的患者。采用美国传染病学会标准和/或美国疾病控制与预防中心标准来定义DSITIS。评估患者数据（流行病学和健康状况）、手术数据、感染特征及表现、分离出的微生物、所需的手术清创、植入物取出以及与感染相关的主要并发症。
分析共纳入174例患者（106例女性）。感染诊断后的平均随访时间为40个月（56例患者随访超过5年）。青少年特发性脊柱侧凸、成人脊柱畸形和退变性腰椎管狭窄是初次手术最常见的病因。59.2%的病例感染表现为早期（首次手术后0 - 3个月），11.5%为延迟期（3 - 24个月），29.3%为晚期（超过24个月）。所有患者均接受了手术清创治疗。20.7%的病例需要进行不止一次手术清创。46.6%的患者取出了植入物（首次手术清创时取出的占72.83%）。最常分离出的微生物是……菌属、肠杆菌科细菌和……菌。14.3%的患者出现了主要并发症，其中超过80%的患者需要进行大手术来解决这些并发症。
晚期DSITIS比之前报道的更为常见。在DSITIS的病原体中，……菌属、肠杆菌科细菌和……菌占主导。DSITIS会导致较高比例的主要并发症，通常需要进行大手术来治疗。
3级
