title: Spinal Implants Can Be Inserted in Patients With Deep Spine Infection: Results From a Large Cohort Study.
abstract: METHODS
  A retrospective, cohort study of 84 patients with deep spine infection managed at a major tertiary hospital over 14 years with a minimum follow up of 2 years.
  
  
  OBJECTIVE
  To determine the role of instrumentation in spines with deep infection.
  
  
  BACKGROUND
  It is often believed that implants should not be inserted in patients with deep spine infection because of the risk of persistent or recurrent infection. However, there are often concerns about spinal stability and a paucity of evidence to guide clinical practice in this field.
  
  
  METHODS
  We compared the mortality, reoperation, and reinfection rates in patients with spine infection treated with antibiotics alone, antibiotics with debridement, and antibiotics with debridement and instrumentation. Significant outcome predictors were determined using multivariable logistic regression model.
  
  
  RESULTS
  Forty-nine males and 35 females with a mean age was 62.0 years had spine infection affecting the lumbar spine predominantly. The most common form of infection was osteomyelitis and spondylodiscitis (69.4%). Staphylococcus aureus was the most common causative organism (61.2%).There was no difference in terms of reoperation or relapse for patients treated with antibiotics alone, antibiotics with debridement, or antibiotics with debridement and instrumentation. However, compared with antibiotics alone, the crude inhospital mortality was lower for patients treated with instrumentation (odds ratio, OR, 0.82; P = 0.01), and antibiotics with debridement (OR 0.80; P = 0.02).
  
  
  CONCLUSIONS
  Spinal instrumentation in an infected spine is safe and not associated with higher reoperation or relapse rates. Mortality is lower for patients treated with instrumentation.
  
  
  METHODS
  3.
authors.affiliation: University Orthopedics, Hand and Reconstructive Microsurgery Cluster National University Health System, Singapore.
authors.forename: Hwee Weng
authors.initials: HW
authors.lastname: Dennis Hey
authors.affiliation: University Orthopedics, Hand and Reconstructive Microsurgery Cluster National University Health System, Singapore.
authors.forename: Li Wen
authors.initials: LW
authors.lastname: Nathaniel Ng
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
authors.forename: Chuen Seng
authors.initials: CS
authors.lastname: Tan
authors.affiliation: Division of Infectious Diseases, University Medicine Cluster, National University Health System, Singapore.
authors.forename: Dale
authors.initials: D
authors.lastname: Fisher
authors.affiliation: Division of Infectious Diseases, University Medicine Cluster, National University Health System, Singapore.
authors.forename: Anupama
authors.initials: A
authors.lastname: Vasudevan
authors.affiliation: University Orthopedics, Hand and Reconstructive Microsurgery Cluster National University Health System, Singapore.
authors.forename: Ka-Po Gabriel
authors.initials: KG
authors.lastname: Liu
authors.affiliation: University Orthopedics, Hand and Reconstructive Microsurgery Cluster National University Health System, Singapore.
authors.forename: Joseph Shantakumar
authors.initials: JS
authors.lastname: Thambiah
authors.affiliation: University Orthopedics, Hand and Reconstructive Microsurgery Cluster National University Health System, Singapore.
authors.forename: Naresh
authors.initials: N
authors.lastname: Kumar
authors.affiliation: University Orthopedics, Hand and Reconstructive Microsurgery Cluster National University Health System, Singapore.
authors.forename: Leok-Lim
authors.initials: LL
authors.lastname: Lau
authors.affiliation: University Orthopedics, Hand and Reconstructive Microsurgery Cluster National University Health System, Singapore.
authors.forename: Hee-Kit
authors.initials: HK
authors.lastname: Wong
authors.affiliation: Division of Infectious Diseases, University Medicine Cluster, National University Health System, Singapore.
authors.forename: Paul Anantharajah
authors.initials: PA
authors.lastname: Tambyah
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001850:Bone Diseases, Infectious / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery*; D003646:Debridement; D015299:Discitis / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D020802:Epidural Abscess / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009026:Mortality; D010019:Osteomyelitis / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D019736:Prostheses and Implants / Q000009:adverse effects; D019919:Prosthesis Implantation / Q000009:adverse effects*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013166:Spondylitis / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery*; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D013211:Staphylococcus aureus / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents