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Diagnostic performance of suction drainage fluid culture for acute surgical site infection after aseptic instrumented spine surgery: a retrospective analysis of 363 cases

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

Analyze the diagnostic performance of suction drainage fluid culture for acute surgical site infection, which has not been specifically reported in spine surgery patients.

Method

This was a retrospective single-center observational study including data from 363 patients who underwent aseptic instrumented spine surgery between 2015 and 2017. A suction drain was inserted in all cases. Data analyzed were patient age, gender, ASA score, indication for surgery (degenerative disease, tumor, trauma), spine level (cervical, thoracic, lumbar), procedure performed and spine level, operative time, body temperature, postoperative C-reactive protein time-curve, clinical aspect of surgical scar, bacteriology results of suction drainage fluid, and in case of revision surgery, lavage fluid. Major criteria for periprosthetic infection proposed by the Musculoskeletal Infection Society (MSIS) were accepted as the gold standard for the diagnosis of acute surgical site infection.

Results

The overall rate of surgical site infection was 6.9% (5.76% for 1- or 2-level fusion, 5.81% for 3- or 4-level fusion, and 15.6% for 5-level fusion and above). The suction drain was withdrawn on the second postoperative day in 44.1% of cases and the third day in 39.1%. The sensitivity of suction drainage fluid culture for the diagnosis of surgical site infection was 20% [95%CI 6.8–40.7%] with a 96.2% [95%CI 93.2–97.9] specificity.

Conclusion

The diagnostic performance of suction drainage fluid culture after aseptic instrumented spine surgery for acute surgical site infection is insufficient to warrant its use in routine practice.

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References

  1. Smith JS et al (2011) Rates of infection after spine surgery based on 108,419 procedures: a report from the scoliosis research society morbidity and mortality committee. Spine 36:556–563

    Article  Google Scholar 

  2. Giordano G (2007) Le drainage en chirurgie orthopédique. Rev Chir Orthop Réparatrice Appar Mot 93(7):26–27 (Supplement 1)

    Article  Google Scholar 

  3. Sankar B et al (2004) Suction drain tip culture in orthopaedic surgery: a prospective study of 214 clean operations. Intern Orthop (SICOT) 28:311–314

    Article  CAS  Google Scholar 

  4. Petsatodis G et al (2009) Prognostic value of suction drain tip culture in determining joint infection in primary and non-infected revision total hip arthroplasty: a prospective comparative study and review of the literature. Arch Orthop Trauma Surg 129:1645–1649

    Article  Google Scholar 

  5. Kobayashi K et al (2015) Is a drain tip culture required after spinal surgery? J Spinal Disord Tech 00:000–000

    Google Scholar 

  6. Takada L et al (2015) Is drain tip culture prognostic of surgical site infection? Results of 1380 drain tip cultures in total hip arthroplasty. J Arthroplasty 30:1407–1409

    Article  Google Scholar 

  7. Jae-Sung A et al (2015) Suction drain tip culture after spine surgery: can it predict a surgical site infection? Asian Spine J 9(6):863–868

    Article  Google Scholar 

  8. Yamada T et al (2016) Drain tip culture is not prognostic for surgical site infection in spinal surgery under prophylactic use of antibiotics. Spine 41(14):1179–1184

    Article  Google Scholar 

  9. Bernard L et al (2002) Drainage fluid culture in orthopedic surgery. Clin Infect Dis 34:46–49

    Article  CAS  Google Scholar 

  10. Parvizi J, Gehrke T, Chen AF (2013) Proceedings of the international consensus on periprosthetic joint infection. Bone Joint J 95:1450–1452

    Article  Google Scholar 

  11. Parvizi J, Zmistowski B, Berbari EF, Bauer TW, Springer B et al (2011) New definitionfor periprosthetic joint infection: from the Workgroup of the MusculoskeletalInfection Society. J Arthroplasty 26:1136–1138

    Article  Google Scholar 

  12. Parvizi JT et al (2018) Definition of periprosthetic hip and knee infection: an evidence-based and validated criteria. J Arthroplasty 33(5):1309–1314.e2

    Article  Google Scholar 

  13. Bonnevialle P, Bonnomet F, Philippe R, Loubignac F, Rubens-Duval B, Talbi A, Le Gall C, Adam P (2012) SOFCOT. early surgical site infection in adult appendicular skeleton trauma surgery: a multicenter prospective series. Orthop Traumatol: Surg Res 98:684–689

    CAS  Google Scholar 

  14. Matter-Parrat V, Ronde-Oustau C, Boéri C, Gaudias J, Jenny J-Y (2017) Agreement between pre-operative and intra-operative bacteriological samples in 85 chronic peri-prosthetic infections. Orthop Traumatol: Surg Res 103(2):301–305

    CAS  Google Scholar 

  15. Parker MJ, Roberts C (2001) Closed suction surgical wound drainage after orthopaedic surgery. Cochrane Database Syst Rev 3:CD001825

    Google Scholar 

  16. Gubin AV, Prudnikova OG, Subramanyam KN et al (2019) Role of closed drain after multi-level posterior spinal surgery in adults: a randomised open-label superiority trial. Eur Spine J 28:146

    Article  Google Scholar 

  17. Devin CJ, Chotai S, McGirt MJ, Vaccaro AR, Youssef JA, Orndorff DG, Arnold PM, Frempong-Boadu AK, Lieberman IH, Branch C, Hedayat HS, Liu A, Wang JC, Isaacs RE, Radcliff KE, Patt JC, Archer K (2018) Intrawound vancomycin decreases the risk of surgical site infection after posterior spine surgery: a multicenter analysis. Spine 43(1):65–71

    Article  Google Scholar 

  18. Hey HW, Thiam DW, Koh ZS, Thambiah JS, Kumar N, Lau LL, Liu KG, Wong HK (2017) Is intraoperative local vancomycin powder the answer to surgical site infections in spine surgery? Spine 42(4):267–274

    Article  Google Scholar 

  19. Tailaiti A, Shang J, Shan S, Muheremu A (2018) Effect of intrawound vancomycin application in spinal surgery on the incidence of surgical site infection: a meta-analysis. Ther Clin Risk Manag 31(14):2149–2159

    Article  Google Scholar 

  20. Dodson V, Majmundar N, Swantic V, Assina R (2019) The effect of prophylactic vancomycin powder on infections following spinal surgeries: a systematic review. Neurosurg Focus 46(1):E11

    Article  Google Scholar 

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Acknowledgements

We thank Dr. Pope Gerald for his help in the translation of this article.

Funding

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Authors and Affiliations

  1. Trauma and Orthopedic Department, Saint Philibert Hospital Center-Lomme, Rue du Grand But-BP 249, 59462, Lomme Cedex, France

    Nathan Ringeval, François Decrucq, Jean François Desrousseaux, Denis Cordonnier & Alexis Perrin

  2. Transveral Infectious Disease Department, Saint Philibert Hospital Center-Lomme, Lomme, France

    Pierre Weyrich

  3. Biostatistics Department, Delegation for Clinical Research and Innovation, Lille Catholic University-Lille, Lille, France

    Sahara Graf

Authors
  1. Nathan Ringeval
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  2. François Decrucq
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  3. Pierre Weyrich
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  4. Jean François Desrousseaux
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  5. Denis Cordonnier
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  6. Sahara Graf
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  7. Alexis Perrin
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Contributions

NR performed the data extraction and was a major contributor in writing the manuscript, FD and PW controlled the microbiological results and helped analyzing them, DC and JFD carefully read and corrected the manuscript, SG performed the biostatistical analyzes, AP designed the study and was a major contributor in writing the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Nathan Ringeval.

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Conflict of interest

All authors certify that they have no conflict of interests.

Data availability and materials

All data are available at the biostatistics laboratory of the Clinical Research Delegation of our institution.

Consent to participate

All patients were informed and had the possibility to refuse to participate.

Consent for publication

Not applicable.

Ethics approval

This study received the approbation from our local ethics committee (CIER: Comité Interne d’Ethique de la Recherche du GHICL), reference number 2018-03-21-A, which ruled that no formal ethics approval was required in this particular case.

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Ringeval, N., Decrucq, F., Weyrich, P. et al. Diagnostic performance of suction drainage fluid culture for acute surgical site infection after aseptic instrumented spine surgery: a retrospective analysis of 363 cases. Eur J Orthop Surg Traumatol 31, 155–160 (2021). https://doi.org/10.1007/s00590-020-02755-7

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  • DOI: https://doi.org/10.1007/s00590-020-02755-7

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