title: Implant survival after deep infection of an instrumented spinal fusion.
abstract: This study evaluates the long-term survival of spinal implants after surgical site infection (SSI) and the risk factors associated with treatment failure. A Kaplan-Meier survival analysis was carried out on 43 patients who had undergone a posterior spinal fusion with instrumentation between January 2006 and December 2008, and who consecutively developed an acute deep surgical site infection. All were appropriately treated by surgical debridement with a tailored antibiotic program based on culture results for a minimum of eight weeks. A 'terminal event' or failure of treatment was defined as implant removal or death related to the SSI. The mean follow-up was 26 months (1.03 to 50.9). A total of ten patients (23.3%) had a terminal event. The rate of survival after the first debridement was 90.7% (95% confidence interval (CI) 82.95 to 98.24) at six months, 85.4% (95% CI 74.64 to 96.18) at one year, and 73.2% (95% CI 58.70 to 87.78) at two, three and four years. Four of nine patients required re-instrumentation after implant removal, and two of the four had a recurrent infection at the surgical site. There was one recurrence after implant removal without re-instrumentation. Multivariate analysis revealed a significant risk of treatment failure in patients who developed sepsis (hazard ratio (HR) 12.5 (95% confidence interval (CI) 2.6 to 59.9); p < 0.001) or who had > three fused segments (HR 4.5 (95% CI 1.25 to 24.05); p = 0.03). Implant survival is seriously compromised even after properly treated surgical site infection, but progressively decreases over the first 24 months.
authors.affiliation: St. Franziskus Hospital and Universitat Autònoma de Barcelona, Spine Surgery, Schönsteinstr 63, Cologne, Germany. snunezpereira@gmail.com
authors.forename: S
authors.initials: S
authors.lastname: Núñez-Pereira
authors.forename: F
authors.initials: F
authors.lastname: Pellisé
authors.forename: D
authors.initials: D
authors.lastname: Rodríguez-Pardo
authors.forename: C
authors.initials: C
authors.lastname: Pigrau
authors.forename: J
authors.initials: J
authors.lastname: Bagó
authors.forename: C
authors.initials: C
authors.lastname: Villanueva
authors.forename: E
authors.initials: E
authors.lastname: Cáceres
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003646:Debridement / Q000379:methods; D020878:Device Removal / Q000379:methods; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants / Q000009:adverse effects*; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D012008:Recurrence; D012086:Reoperation / Q000379:methods; D012307:Risk Factors; D013123:Spinal Fusion / Q000295:instrumentation*; D017211:Treatment Failure; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Implant removal; Infection recurrence; Outcome; Spine; Surgical site infection; Survival