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Acute spinal implant infection treated with debridement: does extended antibiotic treatment improve the prognosis?

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European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

Abstract

The study aims to determine whether 8 weeks of antibiotics is non-inferior to 12 weeks in patients with acute deep spinal implant infection (SII). In the retrospective study of all SII cases (2009–2016), patients aged ≥ 15 years with microbiologically confirmed SII treated with debridement and implant retention were included. Whenever possible, tailored antibiotic treatment was used: rifampin/linezolid in gram-positive and quinolones in gram-negative infection. Patients were divided into short treatment course (8 weeks, ST group) and extended treatment (12 weeks, ET group). Primary outcome measure was percentage of cures at 1-year follow-up. One-hundred-twenty-four patients considered, 48 excluded based on the above criteria, leaving 76 patients, 28 ST and 48 ET. There were no differences in patient age, comorbidities, underlying pathologies, infection location, or surgery characteristics between groups. Surgery-to-debridement time was similar (18.5-day ST vs. 19-day ET; P = 0.96). Sixteen SII cases (21.1%) occurred with bloodstream infection. Pathogens found were Enterobacteriaceae (35, 46.1%), Staphylococcus aureus (29, 38.2%), coagulase-negative staphylococci (12, 15.8%), Pseudomonas aeruginosa (12, 15.8%), and Enterococcus faecalis (7, 9.2%). Twenty seven (35.5%) had polymicrobial infection. E. faecalis was more frequent in the ST group (7, 25% vs. 0; P < 0.001), and P. aeruginosa in ET (1, 3.6% vs. 11, 22.9%; P = 0.05). Five patients died of causes unrelated to SII. At 1-year follow-up, cure rates (21/26 ST, 80.8% vs. 39/45 ET, 86.7%; P = 0.52) and recurrences (2/26, 7.7% vs. 2/45, 4.4%; P = 0.62) were similar. Eight-week antimicrobial courses were not inferior to 12 weeks in patients with acute deep SII treated with prompt debridement, proper wound healing, and optimized antibiotics.

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Acknowledgments

We thank Celine Cavallo for the English language support.

Funding

This work was supported by Plan Nacional de I + D + i 2013–2016 and Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación cooperativa, Ministerio de Economía, Industria y Competitividad, Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003)—cofinanced by European Development Regional Fund “A way to achieve Europe,” Operative program Intelligent Growth 2014–2020.

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Authors and Affiliations

  1. Infectious Diseases Department, University Hospital Vall d’Hebron, Universitat Autónoma de Barcelona, Passeig Vall d’Hebron 119-129, 08035, Barcelona, Spain

    Pau Bosch-Nicolau, Dolors Rodríguez-Pardo, Carles Pigrau & Benito Almirante

  2. Red Española de Investigación en Patología Infecciosa (REIPI), Madrid, Spain

    Dolors Rodríguez-Pardo, Carles Pigrau, Mayli Lung & Benito Almirante

  3. Orthopaedic Surgery Department (Spinal Unit), University Hospital Vall d’Hebrón, Universitat Autónoma de Barcelona, Barcelona, Spain

    Ferran Pellisé & Sleiman Haddad

  4. Microbiology Department, University Hospital Vall d’Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain

    Mayli Lung

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  1. Pau Bosch-Nicolau
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  2. Dolors Rodríguez-Pardo
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Correspondence to Dolors Rodríguez-Pardo.

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Bosch-Nicolau, P., Rodríguez-Pardo, D., Pigrau, C. et al. Acute spinal implant infection treated with debridement: does extended antibiotic treatment improve the prognosis?. Eur J Clin Microbiol Infect Dis 38, 951–958 (2019). https://doi.org/10.1007/s10096-019-03537-8

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