Oral Posters: Values and Outcomes in Spine Surgery

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

Author(s):

R. Bains(1), M. Kardile(1), K. Majid(1), T. Lincoln(1)

(1) Kaiser Permanente, Regional Spine Surgery Dept., Oakland, CA, United States

Abstract

Purpose: Post-op infections involving P acnes present, and are treated, differently from other skin flora infections. Knowledge of the bacteria as a causative agent may aid in its recognition and appropriate treatment. This is becoming the most common bacterium isolated. Design: Retrospective review of 315 consecutive surgical patients treated for Adolescent Idiopathic Scoliosis (AIS) during a 5-year period (2010-2014) at a single institution. Any patient with a postoperative infection following their index surgery was reviewed. There was a minimum of 2-year follow-up following the index surgery. Primary outcome was infection post AIS surgery. Patient charts were reviewed to identify details of their index surgery, time to presentation of the infection, presenting signs/symptoms, details of surgical treatment, microbiology details, antibiotic treatment plans, and outcomes. Infections involving P acnes were compared with other infections.

Results: Of 315 patients with surgery for AIS from 2010-2014, there were 10 post-op infections. Eight of 10 involved P acnes. The average time to presentation was 30 months, with mild pain and swelling as the most common presentation. The 2 cases involving other bacteria were due to MSSA, with an average time to presentation was 3 weeks, and both presented with pain and drainage. Average time to culture growth of P acnes was 6.8 days vs 2.5 days for MSSA infections. All P acnes patients were treated with instrumentation removal, and the most common antibiotic utilized was IV Penicillin G and PO Penicillin VK, usually for an 8-week period.

Conclusion: P acnes was the most commonly isolated bacteria post AIS surgery. Eight of our 10 infections in a 5-year period were due to P acnes. Post-op infections involving P acnes present considerably later than other infections (30 months). They usually present with mild pain and swelling in the area of the prior surgery. In our experience, treatment with debridement, instrumentation removal, and at least 8 weeks of IV antibiotics was universally successful. This study highlights the need to recognize and treat P acnes when there is a clinical suspicion for infection after AIS surgery.