Outcome of spinal implant-associated infections treated with or without biofilm-active antibiotics: results from a 10-year cohort study

作者：Karolin Köder, Sebastian Hardt, Max S. Gellert, Judith Haupenthal, Nora Renz, Michael Putzier, Carsten Perka, Andrej Trampuž · 发表于：Infection · 年份：2020 · DOI：10.1007/s15010-020-01435-2 · 被引用次数：44 · 研究领域：Orthopedic Infections and Treatments、Surgical site infection prevention、Infectious Diseases and Tuberculosis

PURPOSE: Biofilm-active antibiotics are suggested to improve the outcome of implant-associated infections; however, their role in infections after spinal instrumentation is unclear. Therefore, we evaluated the outcome of patients with spinal implant-associated infections treated with and without biofilm-active antibiotics. METHODS: The probability of infection-free survival was estimated for treatment of spinal implant-associated infections with and without biofilm-active antibiotics using the Kaplan-Meier method; Cox proportional-hazards regression model was used to identify factors associated with treatment failure. RESULTS: Among 93 included patients, early-onset infection was diagnosed in 61 (66%) and late-onset in 32 infections (34%). Thirty patients (32%) were treated with biofilm-active antibiotic therapy and 63 (68%) without it. The infection-free survival after a median follow-up of 53.7 months (range, 8 days-9.4 years) was 67% (95% confidence interval [CI], 55-82%) after 1 year and 58% (95% CI 43-71%) after 2 years. The infection-free survival after 1 and 2 years was 94% (95% CI 85-99%) and 84% (95% CI 71-93%) for patients treated with biofilm-active antibiotics, respectively, and 57% (95% CI 39-80%) and 49% (95% CI 28-61%) for those treated without biofilm-active antibiotics, respectively (p = 0.009). Treatment with biofilm-active antibiotics (hazard ratio [HR], 0.23, 95% CI 0.07-0.77), infection with Staphylococcus auras (HR, 2.19, 95% CI 1.04-4.62) and polymicrob...