title: Surgical Site Infections Caused by Methicillin-resistant Staphylococcus epidermidis After Spinal Instrumentation Surgery.
abstract: METHODS
  Retrospective case series.
  
  
  OBJECTIVE
  To determine relevant demographics, clinical presentations, and outcomes of surgical site infections (SSIs) after spinal instrumentation (SI) surgery caused by methicillin-resistant Staphylococcus epidermidis (MRSE).
  
  
  BACKGROUND
  This is the first study looking specifically at MRSE-related SSIs after SI surgery.
  
  
  METHODS
  We performed a retrospective review of patients with MRSE-related SSIs from 665 consecutive cases of SI surgery performed between 2007 and 2014 at our institution.
  
  
  RESULTS
  During the study period, SSIs occurred in 21 patients. MRSE was isolated from cultures obtained from surgical wounds in nine of the 21 patients (43%). There were four males and five females with a mean age of 63.9 ± 15.1 years. Six patients presented with inflammatory signs, such as wound drainage, pyrexia, erythema, and elevated C-reactive protein. Three patients did not have signs of infection, but had early implant failure, and were diagnosed by positive cultures collected at the time of revision surgery. The mean time from index surgery to the diagnosis of infection was 23.6 days (range, 7-88 days). In one patient, the implant was removed before antibiotic treatment was administered because of implant failure. Eight patients were managed with antibiotics and implant retention. During the follow-up period, MRSE-related SSIs in seven of the eight patients were resolved with implant retention and antibiotics without the need for further surgical intervention. One patient did not complete the antibiotic course because of side effects, and implant removal was required to control the infection.
  
  
  CONCLUSIONS
  Early detection, surgical debridement, and administration of appropriate antibiotics for a suitable duration enabled infection control without the need for implant removal in the treatment of MRSE-related SSI after SI surgery.
  
  
  METHODS
  4.
authors.affiliation: Spine Center, Yodakubo Hospital, Nagawa, Nagano, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Takizawa
authors.forename: Takahiro
authors.initials: T
authors.lastname: Tsutsumimoto
authors.forename: Mutsuki
authors.initials: M
authors.lastname: Yui
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Misawa
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016268:Internal Fixators / Q000009:adverse effects* / Q000382:microbiology; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000000981:diagnostic imaging* / Q000601:surgery*; D013203:Staphylococcal Infections / Q000000981:diagnostic imaging* / Q000209:etiology; D013530:Surgical Wound Infection / Q000000981:diagnostic imaging* / Q000209:etiology