General Session: Tumor, Trauma, and Infection

Presented by: M. Ogon - View Audio/Video Presentation (Members Only)

Author(s):

C. Eder(1), P. Landowski(2), G. Angerler(3), M. Toth(4), S. Schildböck(5), M. Ogon(1)

(1) Orthopaedic Hospital Vienna - Speising, Spine Center - Department of Spine Surgery, Vienna, Austria
(2) Krankenhaus Göttlicher Heiland, Department of Vascular Surgery, Vienna, Austria
(3) Orthopaedic Hospital Vienna - Speising, Department of Hospital Hygiene, Vienna, Austria
(4) University of Applied Sciences, Vienna, Austria
(5) Orthopaedic Hospital Vienna - Speising, Spine Research Laboratory, Vienna, Austria

Abstract

Introduction: Surgicial site infections (SSI) represent a major complication of spinal surgery, with the patient´s physiological skin flora being the main reservoir. Aim of the presented study is to analyse the efficacy of routinely used antiseptics against bacterial strains commonly observed in spinal surgical site infections.

Materials and Methods: The bacterial spectrum causing SSI after spinal surgery in our department was analysed retrospectively for 2015. Representative bacterial cultures were harvested from wound swabs and cultivated in Lysogeny Broth medium. Sterillium® and Desmanol® (main active ingredients: Propanol) were tested as hand disinfectants. Braunol® (PVP-iodine), Isozid® (Hexetidin), Kodan® (Propanol, Biphenyol, H2O2) and Octenisept® (Octenidin) were tested for skin resp. wound antisepsis. Bacterial proliferation was monitored by measuring the optical density of the culture medium at 600 nm as well as evaluating the number of colony forming units (CFU) on agar plates.

Results: Bacterial spectrum: Staph. epidermidis was responsible for 37% of the SSIs, followed by Propionibacterium acnes (17%), Enterococcus faecalis (14%), and Proteus mirabilis respectively Staph. aureus accounting for 6% each. Staph. epidermidis, Enterococcus faecalis, Proteus mirabilis and Stap aureus could be cultivated from wound swabs and used for the subsequent evaluation. Evaluation of hand disinfection: While all bacterial strains tested were reduced beyond the level of detection immediately after Desmanol® disinfection, they were still traceable after Sterillium® application (p< 0,0001). Evaluation of skin disinfection: Braunol® was significantly more effective than Kodan® and Isozid® (p< 0,02). 24 hours after disinfection, the number of CFUs per visual field was 1,8 after Braunol® treatment but 8,6 after Isozid® disinfection (p< 0,0001). Octenisept® demonstrated the highest antiseptic effect and was able to reduce all our test strains beyond the level of detection (p< 0,01). A remanent effect was observed using Octenisept® only. After discussion of the results with the OR and hospital hygiene team, a combination of Octenisept® and Kodan® was tested in vitro. Kombined disinfection led to a significant reduction of remaining bacterial load of 89% (Enterococcus) resp. 88% (Staph. aureus) and 44% (Staph. epidermidis) of the values measured after Kodan® disinfection only.

Discussion: Although all antiseptics tested were licensed for surgical antisepsis, significant differences were observed regarding their in vitro activity against a spinal surgery specific bacterial spectrum. A combined disinfection using Octenisept® and Kodan® was able to significantly reduce the remaining bacterial load after disinfection in vitro.