title: Serratia spondylodiscitis after elective lumbar spine surgery: a report of two cases.
abstract: METHODS
  This report describes two cases of acute spondylodiscitis, caused by, complicating two different conditions: microdiscectomy for herniated nucleus pulposus and decompressing laminotomy for spinal stenosis.
  
  
  OBJECTIVE
  To describe a rare and life-threatening spinal infection and discuss its successful management.
  
  
  BACKGROUND
  To our knowledge, no published reports in the English language have described this potentially devastating infection as a complication of elective noninstrumented discectomy or decompressive laminotomy.
  
  
  METHODS
  Two cases of a very early onset of acute spondylodiscitis, caused by, after minimally invasive lumbar spine surgeries are presented. The elapsed time between these two complications was 1 week. The clinical presentation was characteristically stormy in both cases. On postoperative day 2, the patients developed high fever with intense chills and concomitant acute low back pain rapidly increasing in severity. The overall clinical appearance was alarming. The patients were carefully investigated immediately and scrutinized for possible origin of the infection. Treatment consisted of prompt intravenous antibiotics and surgical debridement.
  
  
  RESULTS
  The history and clinical manifestations of postoperative spondylodiscitis were corroborated with magnetic resonance imaging findings and bacteriologic and hematologic laboratory examination. Blood cultures revealed as the responsible pathogenic microorganism. The source of the pathogens was contaminated normal saline used for surgical lavage. Both patients were able to completely resume their previous occupations after aggressive surgical debridement/irrigation and 3 months of antibiotic treatment.
  
  
  CONCLUSIONS
  may become a potential pathogen, causing severe spinal infection after elective surgery. For prompt diagnosis and effective treatment of this life-threatening infection, one should maintain high index of suspicion and should not procrastinate in initiating treatment, which should consist of appropriate intravenous antibiotics and surgical debridement.
authors.affiliation: Department of Orthopaedics-Traumatology, University Hospital of Heraklion, Crete, Greece. ahadjipa@med.uoc.gr
authors.forename: Alexander G
authors.initials: AG
authors.lastname: Hadjipavlou
authors.forename: Ioannis N
authors.initials: IN
authors.lastname: Gaitanis
authors.forename: Charalampos A
authors.initials: CA
authors.lastname: Papadopoulos
authors.forename: Pavlos G
authors.initials: PG
authors.lastname: Katonis
authors.forename: George M
authors.initials: GM
authors.lastname: Kontakis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003646:Debridement; D019299:Decompression, Surgical / Q000009:adverse effects*; D015299:Discitis / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D017587:Diskectomy, Percutaneous / Q000009:adverse effects*; D017558:Elective Surgical Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery; D008161:Lumbosacral Region; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects; D011183:Postoperative Complications / Q000175:diagnosis* / Q000628:therapy; D016868:Serratia Infections / Q000175:diagnosis* / Q000382:microbiology; D012706:Serratia marcescens / Q000302:isolation & purification; D013130:Spinal Stenosis / Q000601:surgery
chemical_list: D000900:Anti-Bacterial Agents