Efficacy of debridement, antibiotic therapy and implant retention within three months during postoperative instrumented spine infections

Authors/contributors
Abstract
Background: Postoperative instrumented spine infection (PISI) is a severe complication of invasive spine procedures. Methods: Retrospective study of patients treated for PISI between 1st January 2008 and 31st December 2012 in a French University Hospital. The objectives of this study were to describe the outcome of patients treated with debridement-irrigation, antibiotic therapy and implant retention (DAIR) within three months after the occurrence of PISI and to identify factors associated with relapse. Results: Among 4290 patients who underwent spinal arthrodesis surgery during the 5-year study period, 129 had PISI treated by debridement-irrigation in the first three months (3.0%, 95% confidence interval [95%CI]: 2.5-3.5). Fifty-two (40%) were female and the median age was 57 years. Fourteen patients (10.8%) had diabetes and 73 (56.6%) had a BMI (Body Mass Index) ≥25 kg/m2. Staphylocccus aureus, enterobacteria or polymicrobial infections were identified in 44.0, 18.0 and 13.0% of cases, respectively. One hundred and six patients (82.2%) and one hundred and twenty-one patients (93.8%) were cured after one DAIR and after two DAIR, respectively. In multivariate logistic analysis, polymicrobial infection was associated with relapse (Odd Ratio [OR] = 3.81; 95%CI: 1.06-13.66; p = .03), while a BMI ≥25 kg/m2 was a protective factor (OR =0.25; 95%CI: 0.07-0.89; p = .03). Conclusion: DAIR may be effective for PISI when performed within the first 3 months after onset of infection. Relapses are significantly associated with polymicrobial infection and negatively associated with moderate overweight. These results need to be confirmed in future prospective studies.
Publication
Infectious Diseases
Date
2017-04-03
Citation
1.
Wille H, Dauchy FA, Desclaux A, et al. Efficacy of debridement, antibiotic therapy and implant retention within three months during postoperative instrumented spine infections. Infectious Diseases. 2017;49(4):261-267.