Predictive Factors for Successful Treatment of Deep Incisional Surgical Site Infections following Instrumented Spinal Surgeries: Retrospective Review of 1832 Cases
Background: Surgical site infection (SSI) is a major complication in spinal instrumentation that is often difficult to treat. The purpose of this study was to identify and determine prognostic indicators for successful treatment of spine instrumentation SSI. Methods: Retrospectively, spine surgery c...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2022-02-01
|
| Series: | Diagnostics |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2075-4418/12/2/551 |
| _version_ | 1797481106562351104 |
|---|---|
| author | Masahiro Kuroiwa Jordy Schol Daisuke Sakai Natsumi Horikita Akihiko Hiyama Hiroyuki Katoh Yukihiro Yamamoto Masato Sato Masahiko Watanabe |
| author_facet | Masahiro Kuroiwa Jordy Schol Daisuke Sakai Natsumi Horikita Akihiko Hiyama Hiroyuki Katoh Yukihiro Yamamoto Masato Sato Masahiko Watanabe |
| author_sort | Masahiro Kuroiwa |
| collection | DOAJ |
| description | Background: Surgical site infection (SSI) is a major complication in spinal instrumentation that is often difficult to treat. The purpose of this study was to identify and determine prognostic indicators for successful treatment of spine instrumentation SSI. Methods: Retrospectively, spine surgery cases were examined on SSI diagnosis. Post-instrumentation SSI patients were categorized as “Successful” if SSI subsided after single debridement. Patients in whom SSI did not subsided and/or required removal of instrumentation were classified as “Challenging”. We investigated the relation of treatment outcomes to patients and treatment factors. Results: A total of 1832 spinal instrumentation cases were recognized with 44 (2.40%) SSI cases. White blood cell count, C-reactive protein (CRP) levels, causative bacteria (i.e., <i>S. Aureus</i> or MRSA), trauma injury, and early-stage antimicrobial agent sensitivity correlated with treatment prognosis. Multivariate analysis highlighted CRP levels and applying early-stage sensitive antibiotics as potential impactful predictive factors for successful treatment. Conclusions: Our results demonstrated that early selection of sensitive antimicrobial agents is critical and emphasizes the potential for early-stage classification methods such as Gram staining. Additionally, <i>S. Aureus</i> and MRSA SSI formed significantly more challenging infections to treat, thus requiring consideration when deciding on instrumentation retention. These factors offer promising aspects for further large-scale studies. |
| first_indexed | 2024-03-09T22:09:46Z |
| format | Article |
| id | doaj.art-c8046d52129f421f92c0d8153beac0a4 |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-09T22:09:46Z |
| publishDate | 2022-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-c8046d52129f421f92c0d8153beac0a42023-11-23T19:34:02ZengMDPI AGDiagnostics2075-44182022-02-0112255110.3390/diagnostics12020551Predictive Factors for Successful Treatment of Deep Incisional Surgical Site Infections following Instrumented Spinal Surgeries: Retrospective Review of 1832 CasesMasahiro Kuroiwa0Jordy Schol1Daisuke Sakai2Natsumi Horikita3Akihiko Hiyama4Hiroyuki Katoh5Yukihiro Yamamoto6Masato Sato7Masahiko Watanabe8Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara 259-1193, JapanDepartment of Orthopaedic Surgery, Tokai University School of Medicine, Isehara 259-1193, JapanDepartment of Orthopaedic Surgery, Tokai University School of Medicine, Isehara 259-1193, JapanDepartment of Orthopaedic Surgery, Tokai University School of Medicine, Isehara 259-1193, JapanDepartment of Orthopaedic Surgery, Tokai University School of Medicine, Isehara 259-1193, JapanDepartment of Orthopaedic Surgery, Tokai University School of Medicine, Isehara 259-1193, JapanDepartment of Orthopaedic Surgery, Tokai University School of Medicine, Isehara 259-1193, JapanDepartment of Orthopaedic Surgery, Tokai University School of Medicine, Isehara 259-1193, JapanDepartment of Orthopaedic Surgery, Tokai University School of Medicine, Isehara 259-1193, JapanBackground: Surgical site infection (SSI) is a major complication in spinal instrumentation that is often difficult to treat. The purpose of this study was to identify and determine prognostic indicators for successful treatment of spine instrumentation SSI. Methods: Retrospectively, spine surgery cases were examined on SSI diagnosis. Post-instrumentation SSI patients were categorized as “Successful” if SSI subsided after single debridement. Patients in whom SSI did not subsided and/or required removal of instrumentation were classified as “Challenging”. We investigated the relation of treatment outcomes to patients and treatment factors. Results: A total of 1832 spinal instrumentation cases were recognized with 44 (2.40%) SSI cases. White blood cell count, C-reactive protein (CRP) levels, causative bacteria (i.e., <i>S. Aureus</i> or MRSA), trauma injury, and early-stage antimicrobial agent sensitivity correlated with treatment prognosis. Multivariate analysis highlighted CRP levels and applying early-stage sensitive antibiotics as potential impactful predictive factors for successful treatment. Conclusions: Our results demonstrated that early selection of sensitive antimicrobial agents is critical and emphasizes the potential for early-stage classification methods such as Gram staining. Additionally, <i>S. Aureus</i> and MRSA SSI formed significantly more challenging infections to treat, thus requiring consideration when deciding on instrumentation retention. These factors offer promising aspects for further large-scale studies.https://www.mdpi.com/2075-4418/12/2/551spinesurgeryinstrumentationsurgical site infectionprognostic factorantibiotics |
| spellingShingle | Masahiro Kuroiwa Jordy Schol Daisuke Sakai Natsumi Horikita Akihiko Hiyama Hiroyuki Katoh Yukihiro Yamamoto Masato Sato Masahiko Watanabe Predictive Factors for Successful Treatment of Deep Incisional Surgical Site Infections following Instrumented Spinal Surgeries: Retrospective Review of 1832 Cases Diagnostics spine surgery instrumentation surgical site infection prognostic factor antibiotics |
| title | Predictive Factors for Successful Treatment of Deep Incisional Surgical Site Infections following Instrumented Spinal Surgeries: Retrospective Review of 1832 Cases |
| title_full | Predictive Factors for Successful Treatment of Deep Incisional Surgical Site Infections following Instrumented Spinal Surgeries: Retrospective Review of 1832 Cases |
| title_fullStr | Predictive Factors for Successful Treatment of Deep Incisional Surgical Site Infections following Instrumented Spinal Surgeries: Retrospective Review of 1832 Cases |
| title_full_unstemmed | Predictive Factors for Successful Treatment of Deep Incisional Surgical Site Infections following Instrumented Spinal Surgeries: Retrospective Review of 1832 Cases |
| title_short | Predictive Factors for Successful Treatment of Deep Incisional Surgical Site Infections following Instrumented Spinal Surgeries: Retrospective Review of 1832 Cases |
| title_sort | predictive factors for successful treatment of deep incisional surgical site infections following instrumented spinal surgeries retrospective review of 1832 cases |
| topic | spine surgery instrumentation surgical site infection prognostic factor antibiotics |
| url | https://www.mdpi.com/2075-4418/12/2/551 |
| work_keys_str_mv | AT masahirokuroiwa predictivefactorsforsuccessfultreatmentofdeepincisionalsurgicalsiteinfectionsfollowinginstrumentedspinalsurgeriesretrospectivereviewof1832cases AT jordyschol predictivefactorsforsuccessfultreatmentofdeepincisionalsurgicalsiteinfectionsfollowinginstrumentedspinalsurgeriesretrospectivereviewof1832cases AT daisukesakai predictivefactorsforsuccessfultreatmentofdeepincisionalsurgicalsiteinfectionsfollowinginstrumentedspinalsurgeriesretrospectivereviewof1832cases AT natsumihorikita predictivefactorsforsuccessfultreatmentofdeepincisionalsurgicalsiteinfectionsfollowinginstrumentedspinalsurgeriesretrospectivereviewof1832cases AT akihikohiyama predictivefactorsforsuccessfultreatmentofdeepincisionalsurgicalsiteinfectionsfollowinginstrumentedspinalsurgeriesretrospectivereviewof1832cases AT hiroyukikatoh predictivefactorsforsuccessfultreatmentofdeepincisionalsurgicalsiteinfectionsfollowinginstrumentedspinalsurgeriesretrospectivereviewof1832cases AT yukihiroyamamoto predictivefactorsforsuccessfultreatmentofdeepincisionalsurgicalsiteinfectionsfollowinginstrumentedspinalsurgeriesretrospectivereviewof1832cases AT masatosato predictivefactorsforsuccessfultreatmentofdeepincisionalsurgicalsiteinfectionsfollowinginstrumentedspinalsurgeriesretrospectivereviewof1832cases AT masahikowatanabe predictivefactorsforsuccessfultreatmentofdeepincisionalsurgicalsiteinfectionsfollowinginstrumentedspinalsurgeriesretrospectivereviewof1832cases |