Predictive Factors for Successful Treatment of Deep Incisional Surgical Site Infections following Instrumented Spinal Surgeries: Retrospective Review of 1832 Cases
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. Patient Selection
3.2. Surgical Site Infection Characteristics
3.3. Instrumentation SSI Subsidence
3.4. Multivariate Analysis
4. Discussion
4.1. SSI Characteristics
4.2. Prognostic Factors for Successful SSI Treatment
4.3. Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Total (n = 68) | No Instrumentation (n = 24) | Instrumentation (n = 44) | S-Group (n = 24) | C-Group (n = 20) | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Family | Micro-Organism | n | (%) | n | (%) | n | (%) | n | (%) | n | (%) | |
Gram-negative | Corynebacteriaceae | Corynebacterium | 1 | 1% | 0 | 0% | 1 | 2% | 0 | 0% | 1 | 5% |
Enterobacteriaceae | Proteus mirabilis | 1 | 1% | 0 | 0% | 1 | 2% | 0 | 0% | 1 | 5% | |
Enterobacter cloaca | 1 | 1% | 0 | 0% | 1 | 2% | 1 | 4% | 0 | 0% | ||
Escherichia coli | 1 | 1% | 0 | 0% | 1 | 2% | 0 | 0% | 1 | 5% | ||
Moraxellaceae | Acinetobacter baumannii | 1 | 1% | 0 | 0% | 1 | 2% | 0 | 0% | 1 | 5% | |
Gram-positive | Enterococcaceae | Enterococcus faecalis | 1 | 1% | 0 | 0% | 1 | 2% | 1 | 4% | 0 | 0% |
Bacillaceae | Bacillus cereus | 1 | 1% | 0 | 0% | 1 | 2% | 0 | 0% | 1 | 5% | |
Staphylococcaceae | Staphylococcus capitis | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | |
Staphylococcus capitis-MR | 7 | 10% | 3 | 13% | 4 | 9% | 4 | 17% | 0 | 0% | ||
Staphylococcus epidermidis | 3 | 4% | 1 | 4% | 2 | 5% | 2 | 8% | 0 | 0% | ||
Staphylococcus epidermidis-MR | 11 | 16% | 5 | 21% | 6 | 14% | 5 | 21% | 1 | 5% | ||
Staphylococcus schleiferi | 1 | 1% | 1 | 4% | 0 | 0% | 0 | 0% | 0 | 0% | ||
Staphylococcus lugdunensis | 1 | 1% | 0 | 0% | 1 | 2% | 0 | 0% | 1 | 5% | ||
Staphylococcus aureus | 6 | 9% | 1 | 4% | 5 | 11% | 3 | 13% | 2 | 10% | ||
Staphylococcus aureus-MR | 26 | 38% | 10 | 42% | 16 | 36% | 4 | 17% | 12 | 60% | ||
Other | Unknown | 9 | 13% | 3 | 13% | 6 | 14% | 6 | 25% | 0 | 0% | |
Cases with polymicrobial infection | 3 | 4% | 0 | 0% | 3 | 7% | 2 | 8% | 1 | 5% | ||
Methicillin-resistant species | 44 | 64.7% | 18 | 75% | 26 | 59% | 14 | 58% | 12 | 60% |
Total | S-Group | C-Group | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Factor | (unit) | Mean | ±sd | n | Mean | (±sd) | n | Mean | (±sd) | n | p-Value |
Age | (years) | 50.7 | ±20.1 | 44 | 20.0 | ±20.0 | 24 | 56.2 | ±19.4 | 20 | 0.056 * |
Fixated vertebrae | (vertebrae) | 4.7 | ±3.4 | 44 | 5.3 | ±4.0 | 24 | 4.0 | ±2.3 | 20 | 0.642 * |
Time onset SSI | (days post-surgery) | 34.7 | ±107.1 | 44 | 15.9 | ±8.5 | 24 | 57.3 | ±157.7 | 20 | 0.986 * |
WBC count | (WBC/μL) | 10,034.1 | ±3964.5 | 44 | 8370.8 | ±2007.7 | 24 | 12,030.0 | ±4796.3 | 20 | 0.002 ** |
CRP levels | (mg/dL) | 10.2 | ±9.3 | 44 | 6.4 | ±8.0 | 24 | 14.8 | ±8.9 | 20 | 0.001 * |
Time until debridement | (days) | 2.4 | ±2.7 | 44 | 2.2 | ±2.8 | 24 | 2.6 | ±2.5 | 20 | 0.388 * |
Debridement time | (min) | 99.8 | ±38.2 | 43 | 97.8 | ±34.5 | 24 | 102.4 | ±43.1 | 19 | 0.695 ** |
Blood loss | (g) | 352.2 | ±329.5 | 40 | 388.4 | ±365.0 | 22 | 308.0 | ±284.1 | 18 | 0.545 * |
Volume saline irrigation | (mL) | 14,848.8 | ±8686.7 | 43 | 13,541.7 | ±5633.6 | 24 | 16,500.0 | ±11,417.6 | 19 | 0.649 * |
Time of closed suction drain | (days) | 5.9 | ±2.6 | 33 | 5.6 | ±2.2 | 21 | 6.6 | ±3.1 | 12 | 0.363 * |
n | % | N | n | % | N | n | % | N | p-value *** | ||
Sex | (male: female) | 18:26 | 44 | 12:12 | 6:14 | 0.227 | |||||
Medical history A | 15 | 34.9% | 43 | 9 | 37.5% | 24 | 6 | 31.6% | 19 | 0.755 | |
Trauma | 20 | 45.5% | 44 | 6 | 25.0% | 24 | 14 | 70.0% | 20 | 0.006 | |
Continious closed irrigation | 3 | 6.8% | 44 | 1 | 4.2% | 24 | 2 | 10.0% | 20 | 0.583 | |
Bacteremia | 25 | 56.8% | 44 | 13 | 54.2% | 24 | 12 | 60.0% | 20 | 0.766 | |
Vancomycin powder | 7 | 15.9% | 44 | 4 | 16.7% | 24 | 3 | 15.0% | 20 | >0.999 | |
Antibiotic sensitivity B | 25 | 65.8% | 38 | 16 | 88.9% | 18 | 9 | 45.0% | 20 | 0.006 | |
Gram-positive species | 34 | 77.3% | 44 | 17 | 70.8% | 24 | 17 | 85.0% | 20 | 0.306 | |
CoNS | 14 | 31.8% | 44 | 11 | 45.8% | 24 | 3 | 15.0% | 20 | 0.050 | |
S. Aureus | 21 | 47.7% | 44 | 7 | 29.2% | 24 | 14 | 70.0% | 20 | 0.014 | |
Gram-negative species | 5 | 11.4% | 44 | 1 | 4.2% | 24 | 4 | 20.0% | 20 | 0.161 | |
MRSA frequency | 16 | 36.4% | 44 | 4 | 16.7% | 24 | 12 | 60.0% | 20 | 0.005 |
Prognostic Factor | OR | 95% CI | p Value |
---|---|---|---|
WBC count | 1.00 | (1.00–1.00) | 0.134 |
CRP levels | 1.11 | (1.00–1.24) | 0.054 |
Trauma | 1.26 | (0.12–12.86) | 0.845 |
Antibiotic sensitivity | 0.08 | (0.01–1.30) | 0.082 |
S. Aureus | 0.56 | (0.02–15.23) | 0.728 |
MRSA | 14.52 | (0.26–798.52) | 0.191 |
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Kuroiwa, M.; Schol, J.; Sakai, D.; Horikita, N.; Hiyama, A.; Katoh, H.; Yamamoto, Y.; Sato, M.; Watanabe, M. Predictive Factors for Successful Treatment of Deep Incisional Surgical Site Infections following Instrumented Spinal Surgeries: Retrospective Review of 1832 Cases. Diagnostics 2022, 12, 551. https://doi.org/10.3390/diagnostics12020551
Kuroiwa M, Schol J, Sakai D, Horikita N, Hiyama A, Katoh H, Yamamoto Y, Sato M, Watanabe M. Predictive Factors for Successful Treatment of Deep Incisional Surgical Site Infections following Instrumented Spinal Surgeries: Retrospective Review of 1832 Cases. Diagnostics. 2022; 12(2):551. https://doi.org/10.3390/diagnostics12020551
Chicago/Turabian StyleKuroiwa, Masahiro, Jordy Schol, Daisuke Sakai, Natsumi Horikita, Akihiko Hiyama, Hiroyuki Katoh, Yukihiro Yamamoto, Masato Sato, and Masahiko Watanabe. 2022. "Predictive Factors for Successful Treatment of Deep Incisional Surgical Site Infections following Instrumented Spinal Surgeries: Retrospective Review of 1832 Cases" Diagnostics 12, no. 2: 551. https://doi.org/10.3390/diagnostics12020551