title: Incidence and risk of delayed surgical site infection following instrumented lumbar spine fusion.
abstract: We reviewed a retrospective case series of patients with delayed infections after spinal fusion, and surveyed medical experts in Canada and the USA regarding their use of prophylactic antibiotics for patients undergoing invasive procedures following spine surgery. Infections after spinal fusion are a relatively common complication, which typically occur early in the postoperative period. Infections which occur more than 3months from the index procedure are rare and are often caused by atypical pathogens. The proportion of infections that required debridement and occurred 6 months after the index procedure was 4.3% (7/162). Over 85% of these infections were polymicrobial, with one third of those containing methicillin-resistant Staphylococcus aureus. The most common operative indications were either trauma or tumour, and most patients with a delayed infection had a distant chronic infection. The majority of spine experts do not routinely recommend prophylactic antibiotics for invasive procedures after spine fusion. In the multivariate analysis, experts were more likely to recommend antibiotics for patients undergoing a non-dental procedure, those who were diabetic, and those who were greater than 1year out from their procedure. In summary, the delayed presentation of infection after instrumented spinal fusion is a rare but serious complication. However, due to its infrequency, routine prophylaxis to prevent haematogenous seeding is likely unnecessary.
authors.affiliation: Combined Neurosurgical and Orthopaedic Spine Program, Vancouver General Hospital, University of British Columbia, 818 West Tenth Avenue, Vancouver, BC V5Z 1M9, Canada. Electronic address: pdlewkon@ucalgary.ca.
authors.forename: Peter
authors.initials: P
authors.lastname: Lewkonia
authors.affiliation: Department of Orthopedics, Spine Division, University of Massachusetts Medical Centre, Worcester, MA, USA.
authors.forename: Christian
authors.initials: C
authors.lastname: DiPaola
authors.affiliation: Combined Neurosurgical and Orthopaedic Spine Program, Vancouver General Hospital, University of British Columbia, 818 West Tenth Avenue, Vancouver, BC V5Z 1M9, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Street
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D013123:Spinal Fusion / Q000009:adverse effects* / Q000379:methods; D013530:Surgical Wound Infection / Q000175:diagnosis* / Q000453:epidemiology* / Q000517:prevention & control; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic prophylaxis; Lumbar vertebrae; Postoperative complication; Surgical wound infection