General Session: Tumor, Trauma, Infection, Image

Presented by: S. McClelland III - View Audio/Video Presentation (Members Only)

Author(s):

S. McClelland III(1), R.C. Takemoto(1), B.S. Lonner(2), A.M. Tate(1), J.J. Park(1), P.A. Ricart-Hoffiz(1), J.A. Bendo(1), J.A. Goldstein(1), J.M. Spivak(1), T.J. Errico(1)

(1) New York University, Division of Spine Surgery, Hospital for Joint Diseases, New York, NY, United States
(2) Mount Sinai Beth Israel, Orthopaedics, New York, NY, United States

Abstract

Introduction: Wound infections following spinal surgery are fraught with morbidity, placing a high toll on both the patient and the healthcare system. Although several large series studies have examined the incidence and distribution of spinal wound infection, the applicability of these studies varies greatly since nearly every study is either retrospective and/or lacks standard inclusion criteria for defining surgical site infection. To address this void, we present results from prospectively gathered thoracolumbar spine surgery data for which the Centers for Disease Control (CDC) criteria were stringently applied to define a surgical site infection (SSI).

Methods: A prospective randomized trial of 314 patients who underwent multilevel thoracolumbar spinal surgery with instrumentation followed by postoperative drain placement was completed (Takemoto et al., 2015). The trial consisted of two antibiotic arms: one for 24-hours, and the other for the duration of the drain; no differences were found between the arms. All infections meeting CDC criteria for SSI were included.

Results: A total of 40 infections met CDC criteria for SSI, for an overall incidence of 12.7%. Of these, 20 (50%) were culture-positive. The most common organism was Staphylococcus aureus (4 total: methicillin-sensitive = 2; methicillin-resistant = 2), followed by coagulase-negative Staphylococcus (3 cases), Propionibacterium acnes and Escherichia coli (each with 2 total). Six of these 20 infections grew multiple organisms, which most commonly involved coagulase-negative staphylococcus and enterococcus. 37 of the 40 infections (93%) involved operative fusion. Exactly half of the 40 infections occurred in revision cases.

Conclusions: In one of the first analyses of prospectively collected thoracolumbar postoperative spine infections meeting CDC criteria, the overall infection incidence was 12.7%, of which only 50% grew organisms on culture. The three most common organisms in our analysis (S. aureus, P. acnes, E. coli) are consistent with previous reports. Our findings indicate that thoracolumbar SSI occurs at the higher end of the range cited in the literature (2-13%), which is largely based on retrospective data not subjected to the inclusivity of SSI as defined by the CDC. Staphylococcus aureus continues to be the most common causative organism and continued vigilance and searching for preventive measures need to be a high priority. Further studies of prospectively collected data using a larger sample size will be needed to better gauge the true incidence and most common causes of thoracolumbar SSI.