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Evaluating the Diagnostic Yield of Computed Tomography-Guided Aspirations in Suspected Post-operative Spine Infections

  • Original Article
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HSS Journal ®

Abstract

Background

Early detection of surgical site infection (SSI) following spinal surgery would allow for prompt treatment and would improve overall outcome, yet early diagnosis is a challenge. Computed tomography (CT) guided aspiration of fluid collections may aid in diagnosis, as its diagnostic utility has previously been demonstrated in the setting of hip SSI, knee SSI, and spontaneous diskitis. There is no literature on its use in post-operative spinal SSIs.

Questions/Purposes

The current study aims to (1) determine the diagnostic value of CT-guided aspiration in evaluating suspected SSI; (2) identify the characteristics of the clinical presentation that are predictive of SSI; and (3) identify characteristics of the hematologic workup that are predictive of SSI.

Methods

Thirty patients who underwent CT-guided aspiration of paraspinal post-operative fluid collections and culture of aspirate fluid over the 6-year period from 2006 to 2011 were retrospectively reviewed. Aspirate fluid culture results were compared to intraoperative cultures, which were used as the “gold standard” for diagnosing SSI. The diagnostic value was evaluated by determining the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of aspirate fluid cultures. Clinical presentation, patient demographics, comorbidities, and laboratory values were reviewed for association with infection risk.

Results

Eleven of thirty patients undergoing CT-guided aspiration were subsequently confirmed to have SSI through positive cultures. Wound drainage, wound erythema, elevated ESR, and cloudiness of aspirate fluid were associated with SSI. The sensitivity and specificity of aspirate cultures were 36.4 and 89.5%, respectively, and the respective positive predictive value (PPV) and negative predictive value (NPV) were 66.7 and 70.8%.

Conclusions

Cloudy aspirate fluid was highly suggestive of infection, while wound erythema, drainage, and elevated ESR were also suggestive of SSI. CT-guided aspirations are a useful adjunct tool in evaluating for SSI but further studies are necessary before it can be considered a stand-alone diagnostic procedure.

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References

  1. Aalto K, Osterman K, Peltola H, Rasanen J. Changes in erythrocyte sedimentation rate and C-reactive protein after total hip arthroplasty. Clin Orthop Relat Res. 1984; 184: 118-120.

    PubMed  Google Scholar 

  2. Austin MS, Ghanem E, Joshi A, Lindsay A, Parvizi J. A simple, cost-effective screening protocol to rule out periprosthetic infection. J Arthroplasty. 2008; 23(1): 65-68.

    Article  PubMed  Google Scholar 

  3. Chew FS, Kline MJ. Diagnostic yield of CT-guided percutaneous aspiration procedures in suspected spontaneous infectious diskitis. Radiology. 2001; 218(1): 211-4.

    Article  CAS  PubMed  Google Scholar 

  4. Della Valle CJ, Sporer SM, Jacobs JJ, Berger RA, Rosenberg AG, Paprosky WG. Preoperative testing for sepsis before revision total knee arthroplasty. J Arthroplasty. 2007; 22(6.2): 90-93.

    Article  PubMed  Google Scholar 

  5. Dietz FR, Koontz FP, Found EM, Marsh JL. The importance of positive bacterial cultures of specimens obtained during clean orthopedic operations. J Bone Joint Surg Am. 1991; 73(8): 1200-1207.

    CAS  PubMed  Google Scholar 

  6. Fang A, Hu SS, Endres N, Bradford DS. Risk factors for infection after spinal surgery. Spine. 2005; 30(12): 1460-1465.

    Article  PubMed  Google Scholar 

  7. Font-Vizcarra L, Garcia S, Martinez-Pastor JC, Sierra JM, Soriano A. Blood culture flasks for culturing synovial fluid in prosthetic joint infections. Clin Orthop Relat Res. 2010; 468(8): 2238-43.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Kocher MS, Zurakowski D, Kasser JR. Differentiating between septic arthritis and transient synovitis of the hip in children: an evidence-based clinical prediction algorithm. J Bone Joint Surg Am. 1999; 81(12): 1662-70.

    CAS  PubMed  Google Scholar 

  9. Lachiewicz PF, Rogers GD, Thomason HC. Aspiration of the hip joint before revision total hip arthroplasty: clinical and laboratory factors influencing attainment of a positive culture. J Bone Joint Surg Am. 1996; 78(5): 749-54.

    CAS  PubMed  Google Scholar 

  10. Larsson S, Thelander U, Friberg S. C-reactive protein (CRP) levels after elective orthopedic surgery. Clin Orthop Relat Res. 1992; 275: 237-42.

    PubMed  Google Scholar 

  11. Mason JB, Fehring TK, Odum SM, Griffin WL, Nussman DS. The value of white blood cell counts before revision total knee arthroplasty. J Arthroplasty. 2003; 18: 1038-43.

    Article  PubMed  Google Scholar 

  12. Mok JM, Pekmezci M, Piper SL, et al. Use of C-reactive protein after spinal surgery: comparison with erythrocyte sedimentation rate as predictor of early postoperative infectious complications. Spine. 2008; 33(4): 415-421.

    Article  PubMed  Google Scholar 

  13. Picada R, Winter RB, Lonstein JE, et al. Postoperative deep wound infection in adults after posterior lumbosacral spine fusion with instrumentation: incidence and management. J Spinal Disord. 2000; 13(1): 42-45.

    Article  CAS  PubMed  Google Scholar 

  14. Pull ter Gunne AF, Cohen DB. Incidence, prevalence, and analysis of risk factors for surgical site infection following adult spinal surgery. Spine. 2009; 34(13): 1422-1428.

    Article  PubMed  Google Scholar 

  15. Rechtine GR, Bono PL, Cahill D, Bolesta MJ, Chrin AM. Postoperative wound infection after instrumentation of thoracic and lumbar fractures. J Orthop Trauma. 2001; 15(8): 566-569.

    Article  CAS  PubMed  Google Scholar 

  16. Roberts P, Walters AJ, McMinn DJW. Diagnosing infection in hip replacements: the use of fine-needle aspiration and radiometric culture. J Bone Joint Surg Br. 1992; 74: 265-69.

    CAS  PubMed  Google Scholar 

  17. Sanzen L, Sundberg M. Periprosthetic low-grade hip infections. Erythrocyte sedimentation rate and C-reactive protein in 23 cases. Acta Orthop Scand. 1997; 68(5): 461-5.

    Article  CAS  PubMed  Google Scholar 

  18. Spangehl MJ, Masri BA, O’Connell JX, Duncan CP. Prospective analysis of preoperative and intraoperative investigations for the diagnosis of infection at the sties of two hundred and two revision total hip arthroplasties. J Bone Joint Surg Am. 1999; 81(5): 672-83.

    CAS  PubMed  Google Scholar 

  19. Sponseller PD, LaPorte DM, Hungerford MW, Eck K, Bridwell KH, Lenke LG. Deep wound infections after neuromuscular scoliosis surgery: a multicenter study of risk factors and treatment outcomes. Spine. 2000; 25(19): 2461-2466.

    Article  CAS  PubMed  Google Scholar 

  20. Stambough JL, Beringer D. Postoperative wound infections complicating adult spine surgery. J Spinal Disord. 1992; 5(3): 277-285.

    Article  CAS  PubMed  Google Scholar 

  21. Taylor T, Beggs I. Fine needle aspiration in infected hip replacements. Clin Radiol. 1995; 50(3): 149-52.

    Article  CAS  PubMed  Google Scholar 

  22. Tunney MM, Patrick S, Curran MD, et al. Detection of prosthetic hip infection at revision arthroplasty by immunofluorescence microscopy and PCR amplification of the bacterial 16S rRNA gene. J Clin Microbiol. 1999; 37(10): 3281-3290.

    CAS  PubMed  PubMed Central  Google Scholar 

  23. Weinstein MA, McCabe JP, Cammisa FP. Postoperative spinal wound infection: a review of 2,391 consecutive index procedures. J Spinal Disord. 2000; 13(5): 422-426.

    Article  CAS  PubMed  Google Scholar 

  24. Wimmer C, Gluch H, Franzreb M, Ogon M. Predisposing factors for infection in spine surgery: a survey of 850 spinal procedures. J of Spinal Disord. 1998; 11(2): 124-128.

    Article  CAS  Google Scholar 

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Correspondence to Jonathan E. Jo MD.

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Conflict of Interest

Jonathan E. Jo, MD, Andy O. Miller MD, Matthew R. Cohn, BS, Venu M. Nemani MD and Robert Schneider, MD have declared that they have no conflict of interest. Darren R. Lebl, MD reports other from Medtronic, K2M and Cohen and Company, outside the work.

Human/Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 [5].

Informed Consent

Informed consent was obtained from all patients for being included in the study.

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Additional information

Level of Evidence: Diagnostic Study Level II. See Levels of Evidence for a complete description.

This work was performed at Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY.

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Jo, J.E., Miller, A.O., Cohn, M.R. et al. Evaluating the Diagnostic Yield of Computed Tomography-Guided Aspirations in Suspected Post-operative Spine Infections. HSS Jrnl 12, 119–124 (2016). https://doi.org/10.1007/s11420-016-9490-z

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  • DOI: https://doi.org/10.1007/s11420-016-9490-z

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