title: The management and outcome of spinal implant infections: contemporary retrospective cohort study.
abstract: BACKGROUND
  Spinal implant infections provide unique diagnostic and therapeutic challenges.
  
  
  METHODS
  We conducted a retrospective cohort study to evaluate risk factors for treatment failure in patients with early- and late-onset spinal implant infections at the Mayo Clinic (Rochester, MN) during 1994-2002.
  
  
  RESULTS
  We identified 30 patients with early-onset spinal implant infection and 51 patients with late-onset spinal implant infection. Twenty-eight of 30 patients with early-onset infection were treated with debridement, implant retention, and antimicrobial therapy. The estimated 2-year cumulative probability of survival free of treatment failure for patients with early-onset infection was 71% (95% confidence interval [CI], 51%-85%). Thirty-two of 51 patients with late-onset infection were treated with implant removal. Their estimated 2-year cumulative probability of survival free of treatment failure was 84% (95% CI, 66%-93%). For patients with early-onset infections, receiving oral antimicrobial suppression therapy was associated with increased cumulative probability of survival (hazard ratio, 0.2; 95% CI, 0.1-0.7). For patients with late-onset infections, implant removal was associated with increased cumulative probability of survival (hazard ratio, 0.3; 95% CI, 0.1-0.7).
  
  
  CONCLUSIONS
  Early-onset spinal implant infections are successfully treated with debridement, implant retention, and parenteral followed by oral suppressive antimicrobial therapy. Implant removal is associated with successful outcomes in late-onset infections.
authors.affiliation: Division of Infectious Diseases, Gundersen Lutheran Medical Center, LaCrosse, WI 54601, USA. tjkowals@gundluth.org
authors.forename: Todd J
authors.initials: TJ
authors.lastname: Kowalski
authors.forename: Elie F
authors.initials: EF
authors.lastname: Berbari
authors.forename: Paul M
authors.initials: PM
authors.lastname: Huddleston
authors.forename: James M
authors.initials: JM
authors.lastname: Steckelberg
authors.forename: Jayawant N
authors.initials: JN
authors.lastname: Mandrekar
authors.forename: Douglas R
authors.initials: DR
authors.lastname: Osmon
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015331:Cohort Studies; D016001:Confidence Intervals; D020878:Device Removal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D011336:Probability; D016016:Proportional Hazards Models; D019736:Prostheses and Implants / Q000009:adverse effects*; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D013122:Spinal Diseases / Q000175:diagnosis / Q000601:surgery*; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents