Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Speising, Vienna, Austria.
Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Speising, Vienna, Austria; Second Department, Orthopaedic Hospital Speising, Vienna, Austria.
Spine J. 2022 Dec;22(12):1934-1943. doi: 10.1016/j.spinee.2022.07.086. Epub 2022 Jul 16.
In severe cases of postoperative spinal implant infections (PSII) multiple revision surgeries may be needed. Little is known if changes in the microbiological spectrum and antibiotic resistance pattern occur between revision surgeries.
Analysis of the microbiological spectrum and antibiotic resistance pattern in patients with multiple revision surgeries for the treatment of PSII STUDY DESIGN: Retrospective database analysis.
Between 01/2011 and 12/2018, 103 patients underwent 248 revision surgeries for the treatment of PSII. Twenty patients (19.4%) who underwent multiple revision surgeries for PSII were included in this study.
Microbiological spectrum, antibiotic resistance pattern.
A retrospective analysis of a prospectively maintained single center spine infection database was performed with a minimum follow-up of 3 years. Overall, 20 patients (six male/14 female) underwent 82 revisions for PSII (median 3; range 2-12). There were 55 of 82 (67.1%) procedures with a positive microbiological result. Microbiological analysis was performed on tissue and implant sonication fluid. Changes in microbial spectrum and antibiotic resistance pattern between surgeries were evaluated using Chi-Square and Fisher's exact test.
In total, 74 microorganisms (83.3% gram-positive; 10.8% gram-negative) were identified. The most common microorganisms were Staphylococcus epidermidis (18.9%) and Cutibacterium acnes (18.9%). All S. epidermidis identified were methicillin-resistant (MRSE). Overall, there were 15 of 55 (27.3%) polymicrobial infections. The microbiological spectrum changed in 57.1% (20/35) between the revision stages over the entire PSII period. In 42.9% (15/35) the microorganism persisted between the revision surgeries stages. Overall, changes of the antibiotic resistance pattern were seen in 17.4% (8/46) of the detected microorganisms, comparing index revision and all subsequent re-revisions. Moreover, higher resistance rates were found for moxifloxacin and for ciprofloxacin at first re-revision surgery compared with index PSII revision. Resistances against vancomycin increased from 4.5% (1/23) at index PSII revision to 7.7% (2/26) at first re-revision surgery.
Changes of the microbiological spectrum and the resistance pattern can occur in patients with severe PSII who require multiple revision surgeries. It is important to consider these findings in the antimicrobial treatment of PSII. The microbiological analysis of intraoperative tissue samples should be performed at every revision procedure for PSII.
在严重的术后脊柱植入物感染（PSII）的情况下，可能需要多次翻修手术。对于治疗 PSII 的多次翻修手术之间微生物谱和抗生素耐药模式是否发生变化，知之甚少。
分析治疗 PSII 的多次翻修手术患者的微生物谱和抗生素耐药模式。
回顾性数据库分析。
2011 年 1 月至 2018 年 12 月，103 例患者因 PSII 行 248 次翻修手术。本研究纳入了 20 例（19.4%）因 PSII 行多次翻修手术的患者。
微生物谱、抗生素耐药模式。
对前瞻性维护的单中心脊柱感染数据库进行回顾性分析，随访时间至少 3 年。总体而言，20 例患者（6 例男性/14 例女性）因 PSII 行 82 次翻修（中位数 3；范围 2-12）。55/82（67.1%）例有阳性微生物学结果。对组织和植入物超声雾化液进行微生物分析。使用卡方检验和 Fisher 精确检验评估手术之间微生物谱和抗生素耐药模式的变化。
共鉴定出 74 种微生物（83.3%为革兰氏阳性菌；10.8%为革兰氏阴性菌）。最常见的微生物是表皮葡萄球菌（18.9%）和痤疮丙酸杆菌（18.9%）。所有鉴定的表皮葡萄球菌均为耐甲氧西林（MRSE）。总体而言，55 例（27.3%）为混合感染。在整个 PSII 期间，整个 PSII 期间，57.1%（20/35）的微生物谱在不同的翻修阶段发生了变化。42.9%（15/35）的微生物在翻修阶段之间持续存在。总体而言，与索引翻修相比，在所有后续再翻修中，46 个检测到的微生物中有 17.4%（8/46）的抗生素耐药模式发生了变化。此外，与首次再翻修手术相比，莫西沙星和环丙沙星的耐药率更高。万古霉素的耐药率从指数 PSII 翻修时的 4.5%（1/23）增加到首次再翻修手术时的 7.7%（2/26）。
严重 PSII 需要多次翻修手术的患者可能会出现微生物谱和耐药模式的变化。在治疗 PSII 时应考虑这些发现。对于 PSII 的每次翻修手术，都应进行术中组织样本的微生物分析。
