title: Efficacy of debridement, antibiotic therapy and implant retention within three months during postoperative instrumented spine infections.
abstract: BACKGROUND
  Postoperative instrumented spine infection (PISI) is a severe complication of invasive spine procedures.
  
  
  METHODS
  Retrospective study of patients treated for PISI between 1st January 2008 and 31st December 2012 in a French University Hospital. The objectives of this study were to describe the outcome of patients treated with debridement-irrigation, antibiotic therapy and implant retention (DAIR) within three months after the occurrence of PISI and to identify factors associated with relapse.
  
  
  RESULTS
  Among 4290 patients who underwent spinal arthrodesis surgery during the 5-year study period, 129 had PISI treated by debridement-irrigation in the first three months (3.0%, 95% confidence interval [95%CI]: 2.5-3.5). Fifty-two (40%) were female and the median age was 57 years. Fourteen patients (10.8%) had diabetes and 73 (56.6%) had a BMI (Body Mass Index) ≥25 kg/m2. Staphylocccus aureus, enterobacteria or polymicrobial infections were identified in 44.0, 18.0 and 13.0% of cases, respectively. One hundred and six patients (82.2%) and one hundred and twenty-one patients (93.8%) were cured after one DAIR and after two DAIR, respectively. In multivariate logistic analysis, polymicrobial infection was associated with relapse (Odd Ratio [OR] = 3.81; 95%CI: 1.06-13.66; p = .03), while a BMI ≥25 kg/m2was a protective factor (OR =0.25; 95%CI: 0.07-0.89; p = .03).
  
  
  CONCLUSIONS
  DAIR may be effective for PISI when performed within the first 3 months after onset of infection. Relapses are significantly associated with polymicrobial infection and negatively associated with moderate overweight. These results need to be confirmed in future prospective studies.
authors.affiliation: a Department of Infectious and Tropical Diseases , University Hospital of Bordeaux, Centre de Référence Infections Ostéo-articulaires, Hôpital Pellegrin , Bordeaux , France.|b Department of Infectious and Tropical Diseases , Centre Hospitalier de la Côte Basque , Bayonne , France.
authors.forename: Heidi
authors.initials: H
authors.lastname: Wille
authors.affiliation: a Department of Infectious and Tropical Diseases , University Hospital of Bordeaux, Centre de Référence Infections Ostéo-articulaires, Hôpital Pellegrin , Bordeaux , France.
authors.forename: Frédéric-Antoine
authors.initials: FA
authors.lastname: Dauchy
authors.affiliation: a Department of Infectious and Tropical Diseases , University Hospital of Bordeaux, Centre de Référence Infections Ostéo-articulaires, Hôpital Pellegrin , Bordeaux , France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Desclaux
authors.affiliation: a Department of Infectious and Tropical Diseases , University Hospital of Bordeaux, Centre de Référence Infections Ostéo-articulaires, Hôpital Pellegrin , Bordeaux , France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Dutronc
authors.affiliation: a Department of Infectious and Tropical Diseases , University Hospital of Bordeaux, Centre de Référence Infections Ostéo-articulaires, Hôpital Pellegrin , Bordeaux , France.|b Department of Infectious and Tropical Diseases , Centre Hospitalier de la Côte Basque , Bayonne , France.
authors.forename: Marc-Olivier
authors.initials: MO
authors.lastname: Vareil
authors.affiliation: c Laboratory of Microbiology , University Hospital of Bordeaux , Bordeaux , France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Dubois
authors.affiliation: d Spine Unit One, Orthopaedic Surgery , University Hospital of Bordeaux , Bordeaux , France.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Vital
authors.affiliation: a Department of Infectious and Tropical Diseases , University Hospital of Bordeaux, Centre de Référence Infections Ostéo-articulaires, Hôpital Pellegrin , Bordeaux , France.
authors.forename: Michel
authors.initials: M
authors.lastname: Dupon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003646:Debridement; D005260:Female; D005602:France; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000628:therapy*; D012189:Retrospective Studies; D013166:Spondylitis / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Post-operative infection; joint and bone infection; spinal surgery