title: Analysis of Postoperative Thoracolumbar Spine Infections in a Prospective Randomized Controlled Trial Using the Centers for Disease Control Surgical Site Infection Criteria.
abstract: BACKGROUND
  Wound infections following spinal surgery place a high toll on both the patient and the healthcare system. Although several large series studies have examined the incidence and distribution of spinal wound infection, the applicability of these studies varies greatly since nearly every study is either retrospective and/or lacks standard inclusion criteria for defining surgical site infection. To address this void, we present results from prospectively gathered thoracolumbar spine surgery data for which the Centers for Disease Control (CDC) criteria were stringently applied to define a surgical site infection (SSI).
  
  
  METHODS
  A prospective randomized trial of 314 patients who underwent multilevel thoracolumbar spinal surgery with instrumentation followed by postoperative drain placement was completed (Takemoto et al., 2015). The trial consisted of two antibiotic arms: one for 24-hours, and the other for the duration of the drain; no differences were found between the arms. All infections meeting CDC criteria for SSI were included.
  
  
  RESULTS
  A total of 40 infections met CDC criteria for SSI, for an overall incidence of 12.7%. Of these, 20 (50%) were culture-positive. The most common organism was Staphylococcus aureus (4 total: methicillin-sensitive=2; methicillin-resistant=2), followed by coagulase-negative Staphylococcus (3 cases), Propionibacterium acnes and Escherichia coli (2 cases each). Six infections grew multiple organisms, most commonly involving coagulase-negative staphylococcus and enterococcus.
  
  
  CONCLUSIONS
  Our findings indicate that thoracolumbar SSI occurs at the higher end of the range cited in the literature (2-13%), which is largely based on retrospective data not subjected to the inclusivity of SSI as defined by the CDC. The three most common organisms in our analysis (S. aureus, P. acnes, E. coli) are consistent with previous reports. Staphylococcus aureus continues to be the most common causative organism and continued vigilance and searching for preventive measures need to be a high priority. This study provides Level I evidence.
authors.affiliation: Division of Spine Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, NY.
authors.forename: Shearwood
authors.initials: S
authors.lastname: McClelland
authors.affiliation: Division of Spine Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, NY.
authors.forename: Richelle C
authors.initials: RC
authors.lastname: Takemoto
authors.affiliation: Department of Orthopaedics, Mount Sinai Beth Israel, New York, NY.
authors.forename: Baron S
authors.initials: BS
authors.lastname: Lonner
authors.affiliation: Division of Spine Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, NY.
authors.forename: Tate M
authors.initials: TM
authors.lastname: Andres
authors.affiliation: Division of Spine Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, NY.
authors.forename: Justin J
authors.initials: JJ
authors.lastname: Park
authors.affiliation: Division of Spine Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, NY.
authors.forename: Pedro A
authors.initials: PA
authors.lastname: Ricart-Hoffiz
authors.affiliation: Division of Spine Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, NY.
authors.forename: John A
authors.initials: JA
authors.lastname: Bendo
authors.affiliation: Division of Spine Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, NY.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Goldstein
authors.affiliation: Division of Spine Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, NY.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Spivak
authors.affiliation: Division of Spine Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, NY.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Errico
keywords: centers for disease control criteria; propionibacterium acnes; prospective data collection; staphylococcus aureus; surgical site infection; thoracolumbar spine surgery