Advertisement

Surgical Site Infections in Spine Surgery: Prevention, Diagnosis, and Treatment Using a Multidisciplinary Approach

  • Matthew Scott-YoungEmail author
  • Mario Zotti
  • Robert G. Fassett
Living reference work entry

Abstract

Surgical site infections (SSIs) after spinal surgery are an important cause of postoperative morbidity and a multidisciplinary approach should focus on prevention. Screening for preoperative and recognition of intraoperative risk factors that increase the incidence of SSIs should be routine practice. Factors shown to influence SSIs include diabetes, obesity, previous SSI, complex multilevel procedures, and excessive surgical time and blood loss.

Multidisciplinary awareness and monitoring for SSIs is required with a high index of suspicion based on a combination of clinical findings including pain in the surgical area, swelling, fever, and wound discharge and diagnostic tests including WCC, CRP, ESR, wound microbiology, and blood cultures. Imaging the area with ultrasound, CT, or MRI and guided needle sampling of any detected collections may be required. Prompt treatment with antibiotics reflecting regional bacterial isolates and their sensitivity patterns should be implemented. Surgical wound wash outs, often performed repeatedly, may be necessary in selected cases.

Keywords

Surgical site infection Prevention Risk factors Diagnosis Management Staphylococcus aureus Implant multidisciplinary Inflammatory markers Spinal surgery 

References

  1. Abdul-Jabbar A, Berven SH, Hu SS, Chou D, Mummaneni PV, Takemoto S et al (2013) Surgical site infections in spine surgery: identification of microbiologic and surgical characteristics in 239 cases. Spine 38(22):1425–1431.  https://doi.org/10.1097/BRS.0b013e3182a42a68CrossRefGoogle Scholar
  2. Brown EM, Pople IK, de Louvois J, Hedges A, Bayston R, Eisenstein SM, Lees P (2004) Spine Update. Spine 29(8):938–945.  https://doi.org/10.1097/00007632-200404150-00023CrossRefPubMedGoogle Scholar
  3. Catanzano A, Phillips M, Dubrovskaya Y, Hutzler L, Bosco J (2014) The standard one gram dose of vancomycin is not adequate prophylaxis for MRSA. Iowa Orthop J 34:111–117. Retrieved from http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4127722&tool=pmcentrez&rendertype=abstractPubMedPubMedCentralGoogle Scholar
  4. Chahoud J, Kanafani Z, Kanj SS (2014) Surgical site infections following spine surgery: eliminating the controversies in the diagnosis. Front Med 1(March 2015).  https://doi.org/10.3389/fmed.2014.00007
  5. Chan T-C, Luk JK-H, Chu L-W, Chan FH-W (2014) Validation study of Charlson comorbidity index in predicting mortality in Chinese older adults. Geriatr Gerontol Int 14(2):452–457.  https://doi.org/10.1111/ggi.12129CrossRefPubMedGoogle Scholar
  6. Chen AF, Nana AD, Nelson SB, McLaren A (2017) What’s new in musculoskeletal infection: update across orthopaedic subspecialties. JBJS [Am] 99(14):1232–1243.  https://doi.org/10.2106/JBJS.17.00421CrossRefGoogle Scholar
  7. Collins I, Wilson-MacDonald J, Chami G, Burgoyne W, Vineyakam P, Berendt T, Fairbank J (2008) The diagnosis and management of infection following instrumented spinal fusion. Eur Spine J 17(3):445–450.  https://doi.org/10.1007/s00586-007-0559-8CrossRefPubMedGoogle Scholar
  8. Cornett CA, Vincent SA, Crow J, Hewlett A (2016) Bacterial spine infections in adults: evaluation and management. J Am Acad Orthop Surg 24(1):11–18.  https://doi.org/10.5435/JAAOS-D-13-00102CrossRefPubMedGoogle Scholar
  9. Devin CJ, Chotai S, McGirt MJ, Vaccaro AR, Youssef JA, Orndorff DG et al (2015) Intrawound vancomycin decreases the risk of surgical site infection after posterior spine surgery–a multicenter analysis. Spine 1.  https://doi.org/10.1097/BRS.0000000000001371CrossRefGoogle Scholar
  10. Fukuda H, Morikane K, Kuroki M, Taniguchi S, Shinzato T, Sakamoto F et al (2013) Toward the rational use of standardized infection ratios to benchmark surgical site infections. Am J Infect Control 41(9):810–814.  https://doi.org/10.1016/j.ajic.2012.10.004CrossRefPubMedGoogle Scholar
  11. Garg V, Kosmas C, Josan ES, Partovi S, Bhojwani N, Fergus N, …, Robbin MR (2016) Hybrid biopsy technique to improve yield 41(August):1–9.  https://doi.org/10.3171/2016.4.FOCUS1614CrossRefGoogle Scholar
  12. Godil SS, Parker SL, O’Neill KR, Devin CJ, McGirt MJ (2013) Comparative effectiveness and cost-benefit analysis of local application of vancomycin powder in posterior spinal fusion for spine trauma: clinical article. J Neurosurg Spine 19(3):331–335.  https://doi.org/10.3171/2013.6.SPINE121105CrossRefPubMedGoogle Scholar
  13. Gruenberg MF, Campaner GL, Sola CA, Ortolan EG (2004) Ultraclean air for prevention of postoperative infection after posterior spinal fusion with instrumentation: a comparison between surgeries performed with and without a vertical exponential filtered air-flow system. Spine 29(20):2330–2334.  https://doi.org/10.1097/01.brs.0000142436.14735.53CrossRefPubMedGoogle Scholar
  14. Kang B-U, Choi W-C, Lee S-H, Jeon SH, Park JD, Maeng DH, Choi Y-G (2009) An analysis of general surgery–related complications in a series of 412 minilaparotomic anterior lumbosacral procedures. J Neurosurg Spine 10(1):60–65.  https://doi.org/10.3171/2008.10.SPI08215CrossRefPubMedGoogle Scholar
  15. Kawabata A, Sakai K, Sato H, Sasaki S, Torigoe I, Tomori M et al (2017) Methicillin-resistant Staphylococcus aureus nasal swab and suction drain tip cultures in 4573 spinal surgeries: efficacy in Management of Surgical Site Infections. Spine 1.  https://doi.org/10.1097/BRS.0000000000002360CrossRefGoogle Scholar
  16. Mangram AJ, Horan TC, Pearson L et al (1999) Guideline for prevention of surgical site infection, 1999. Am J Infect Control 20(4):250–278Google Scholar
  17. McGirt MJ, Parker SL, Lerner J, Engelhart L, Knight T, Wang MY (2011) Comparative analysis of perioperative surgical site infection after minimally invasive versus open posterior/transforaminal lumbar interbody fusion: analysis of hospital billing and discharge data from 5170 patients. J Neurosurg Spine 14(6):771–778.  https://doi.org/10.3171/2011.1.SPINE10571CrossRefPubMedGoogle Scholar
  18. Mehta S, Hadley S, Hutzler L, Slover J, Phillips M, Bosco JA (2013) Impact of preoperative MRSA screening and decolonization on hospital-acquired MRSA burden infection. Clin Orthop Relat Res 471(7):2367–2371.  https://doi.org/10.1007/s11999-013-2848-3CrossRefPubMedPubMedCentralGoogle Scholar
  19. Mistovich RJ, Jacobs LJ, Campbell RM, Spiegel DA, Flynn JM, Baldwin KD (2017) Infection control in pediatric spinal deformity surgery. JBJS Reviews 5(5):e3.  https://doi.org/10.2106/JBJS.RVW.16.00071CrossRefPubMedGoogle Scholar
  20. Molinari RW, Khera OA, Molinari WJ III (2012) Prophylactic intraoperative powdered vancomycin and postoperative deep spinal wound infection: 1,512 consecutive surgical cases over a 6-year period. Eur Spine J 21(S4):476–482.  https://doi.org/10.1007/s00586-011-2104-zCrossRefGoogle Scholar
  21. Oichi T, Oshima Y, Takeshita K, Chikuda H, Tanaka S (2015) Evaluation of comorbidity indices for a study of patient outcomes following cervical decompression surgery: a retrospective cohort study. Spine 40(24):1941–1947.  https://doi.org/10.1097/BRS.0000000000001153CrossRefPubMedGoogle Scholar
  22. Petignat C, Francioli P, Harbarth S, Regli L, Porchet F, Reverdin A et al (2008) Cefuroxime prophylaxis is effective in noninstrumented spine surgery: a double-blind, placebo-controlled study. Spine 33(18):1919–1924.  https://doi.org/10.1097/BRS.0b013e31817d97cfCrossRefPubMedGoogle Scholar
  23. Pichelmann MA, Dekutoski MB (2011) Complications related to anterior and lateral lumbar surgery. Semin Spine Surg 23(2):91–100.  https://doi.org/10.1053/j.semss.2010.12.012CrossRefGoogle Scholar
  24. Pull Ter Gunne AF, Cohen DB (2009) Incidence, prevalence, and analysis of risk factors for surgical site infection following adult spinal surgery. Spine 34(13):1422–1428.  https://doi.org/10.1097/BRS.0b013e3181a03013CrossRefPubMedGoogle Scholar
  25. Quan H, Li B, Couris CM, Fushimi K, Graham P, Hider P et al (2011) Updating and validating the charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol 173(6):676–682.  https://doi.org/10.1093/aje/kwq433CrossRefPubMedPubMedCentralGoogle Scholar
  26. Schoenfeld AJ, Ochoa LM, Bader JO, Belmont PJ Jr (2011) Risk factors for immediate postoperative complications and mortality following spine surgery: a study of 3475 patients from the National Surgical Quality Improvement Program. J Bone Joint Surg Am 93(17):1577–1582.  https://doi.org/10.2106/JBJS.J.01048[doi]CrossRefPubMedGoogle Scholar
  27. Schroeder JE, Girardi FP, Sandhu H, Weinstein J, Cammisa FP, Sama A (2016) The use of local vancomycin powder in degenerative spine surgery. Eur Spine J 25(4):1029–1033.  https://doi.org/10.1007/s00586-015-4119-3CrossRefPubMedGoogle Scholar
  28. Smith JS, Shaffrey CI, Sansur CA, Berven SH, Fu KMG, Broadstone PA 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(7):556–563.  https://doi.org/10.1097/BRS.0b013e3181eadd41CrossRefPubMedGoogle Scholar
  29. Te Cheng M, Chang MC, Wang ST, Yu WK, Liu CL, Chen TH (2005) Efficacy of dilute betadine solution irrigation in the prevention of postoperative infection of spinal surgery. Spine 30(15):1689–1693.  https://doi.org/10.1097/01.brs.0000171907.60775.85CrossRefPubMedGoogle Scholar
  30. Tofuku K, Koga H, Yanase M, Komiya S (2012) The use of antibiotic-impregnated fibrin sealant for the prevention of surgical site infection associated with spinal instrumentation. Eur Spine J 21(10):2027–2033.  https://doi.org/10.1007/s00586-012-2435-4CrossRefPubMedPubMedCentralGoogle Scholar
  31. Van Middendorp JJ, Pull Ter Gunne AF, Schuetz M, Habil D, Cohen DB, Hosman AJF, Van Laarhoven CJHM (2012) A methodological systematic review on surgical site infections following spinal surgery: part 2: prophylactic treatments. Spine 37(24):2034–2045.  https://doi.org/10.1097/BRS.0b013e31825f6652CrossRefPubMedGoogle Scholar
  32. Walid MS, Robinson JS (2011) Economic impact of comorbidities in spine surgery. J Neurosurg Spine 14(3):318–321.  https://doi.org/10.3171/2010.11.SPINE10139CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Matthew Scott-Young
    • 1
    • 2
    Email author
  • Mario Zotti
    • 3
  • Robert G. Fassett
    • 1
    • 4
  1. 1.Faculty of Health Sciences & MedicineBond UniversityGold CoastAustralia
  2. 2.Queensland Spinal Surgeon, Gold Coast SpineSouthportAustralia
  3. 3.Gold Coast SpineSouthportAustralia
  4. 4.Schools of Medicine and Human Movement and Nutrition SciencesThe University of QueenslandSt LuciaAustralia

Section editors and affiliations

  • Matthew N. Scott-Young
    • 1
    • 2
  1. 1.Gold Coast SpineSouthportAustralia
  2. 2.Faculty of Health Sciences & MedicineBond UniversityVarsity LakesAustralia

Personalised recommendations