Management of late-onset deep surgical site infection after instrumented spinal surgery

作者：Dong Yin, Bin Liu, Yunbing Chang, Honglin Gu, Xiaoqing Zheng · 发表于：BMC Surgery · 年份：2018 · DOI：10.1186/s12893-018-0458-4 · 被引用次数：80 · 研究领域：Surgical site infection prevention、Orthopedic Infections and Treatments、Infectious Diseases and Tuberculosis

BACKGROUND: There are no universally accepted protocols for the treatment of late-onset deep surgical site infection. This study retrospectively evaluates the methods of aggressive debridement with instrumentation retention, high vacuum closed-suction drain without irrigation, primary wound closure, and antibiotic therapy for the treatment of late-onset deep surgical site infection after instrumented spinal surgery. METHODS: A total of 4057 patients who underwent instrumented spinal surgeries were surveyed from January 2010 to June 2014. Surgical debridement was performed immediately after late-onset deep surgical site infection was identified. In addition to extended resection of the devitalized and necrotic tissue, the biofilms adhered to the surface of implants were removed meticulously and thoroughly. Primary wound closure was performed on each patient, and closed suction drains were maintained for about 7-10 days without irrigation. Antibiotic therapy was administered for 3 months according to the results of the pathogenic culture. RESULTS: Forty-two patients were identified as having late-onset deep surgical site infection. Staphylococcus aureus was the most common pathogen in this group. Seven patients with late-onset deep surgical site infection had negative bacterial culture results. Infections resolved in all patients. Forty-one patients retained their instrumentation, whereas 1 patient had the implants removed because of Staphylococcus aureus infection, which was f...