Efficacy and Limitations of Continuous Local Antibiotic Perfusion in Treating Surgical Site Infections Following Instrumented Spinal Surgery: A Retrospective Multicenter Study.

IF 4.7 3区医学 Q1 INFECTIOUS DISEASES

Infectious Diseases and Therapy Pub Date : 2025-02-01 Epub Date: 2025-01-07 DOI:10.1007/s40121-024-01095-x

Hiroshi Takahashi, Kohei Okuyama, Yasunori Toki, Toru Funayama, Hiroshi Noguchi, Kousei Miura, Hisanori Gamada, Shun Okuwaki, Yosuke Ogata, Kotaro Sakashita, Takahiro Sunami, Takane Nakagawa, Kengo Fujii, Tetsuhiro Ishikawa, Geundong Kim, Mitsutoshi Ota, Taigo Inada, Daisuke Himeno, Hiromitsu Takaoka, Masahiro Suzuki, Satoshi Maki, Masahiro Inoue, Kazuhide Inage, Yasuhiro Shiga, Takeo Furuya, Yawara Eguchi, Sumihisa Orita, Seiji Ohtori, Masashi Yamazaki, Masao Koda

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引用次数: 0

Abstract

Introduction: Surgical site infection (SSI) is one of the most serious postoperative complications following instrumented spinal surgery. We previously reported the potential of continuous local antibiotic perfusion (CLAP) to retain implants for patients with SSI following instrumented spinal surgery. We conducted a retrospective multicenter study to elucidate the efficacy and limitations of CLAP for patients with SSI following instrumented spinal surgery.

Methods: A total of 40 patients treated with CLAP for SSI after instrumented spinal surgery were included in this study. The implant retention rate was calculated. We investigated the influence of age, presence of diabetes, number of fused vertebrae, causative pathogens, duration from diagnosis to CLAP initiation, white blood cell (WBC) count (× 10³/μL), and C-reactive protein (CRP) level on the development of SSI after CLAP. Patients were divided into two groups: a favorable outcome group (n = 28), in which SSI was promptly controlled after CLAP, and a poor outcome group (n = 12), in which additional surgery was required or fatal outcomes occurred after CLAP. The relationship between these two groups was evaluated.

Results: In 13 of 40 patients, implants had already been removed before CLAP initiation. Excluding these cases, control of SSI with implant retention was achieved by CLAP in 22 of 27 patients (81%). In the poor outcome group, antibiotic-resistant pathogens were detected at a higher rate than in the favorable outcome group (p = 0.022), and the WBC counts at 1 week after CLAP were significantly increased compared with the favorable outcome group (poor outcome group 7.7 ± 2.4, favorable outcome group 5.8 ± 1.6; p = 0.013).

Conclusions: Application of CLAP enabled SSI control with a high rate of implant retention. However, detection of antibiotic-resistant pathogens and increased WBC count 1 week after initiating CLAP may predict poor control of SSI, even after CLAP.

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持续局部抗生素灌注治疗脊柱器械手术后手术部位感染的疗效和局限性：一项回顾性多中心研究。

手术部位感染（SSI）是脊柱固定手术后最严重的并发症之一。我们之前报道了持续局部抗生素灌注（CLAP）用于固定脊柱手术后SSI患者保留植入物的潜力。我们进行了一项回顾性多中心研究，以阐明CLAP对固定脊柱手术后SSI患者的疗效和局限性。方法：选取40例脊柱固定手术后并发淋病的SSI患者作为研究对象。计算种植体固位率。研究年龄、有无糖尿病、椎体融合数、致病菌、诊断至发病时间、白细胞（WBC）计数（× 103/μL）、c反应蛋白（CRP）水平等因素对淋病后SSI发生的影响。患者被分为两组：预后良好组（n = 28），其中啪啪啪后SSI得到及时控制；预后不良组（n = 12），其中啪啪啪后需要额外手术或发生致命结局。评估两组之间的关系。结果：在40例患者中，有13例在CLAP开始前已经移除种植体。排除这些病例，27例患者中有22例（81%）通过CLAP控制了种植体保留的SSI。不良结局组耐药病原菌检出率高于良好结局组（p = 0.022），淋病后1周WBC计数明显高于良好结局组(不良结局组7.7±2.4，良好结局组5.8±1.6；p = 0.013)。结论：应用CLAP使SSI控制具有较高的种植体固位率。然而，在开始淋病后1周检测到耐药病原体和白细胞计数增加可能预示SSI控制不良，即使在淋病后也是如此。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Infectious Diseases and Therapy Medicine-Microbiology (medical)

CiteScore

8.60

自引率

1.90%

发文量

136

审稿时长

6 weeks

期刊介绍： Infectious Diseases and Therapy is an international, open access, peer-reviewed, rapid publication journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of infectious disease therapies and interventions, including vaccines and devices. Studies relating to diagnostic products and diagnosis, pharmacoeconomics, public health, epidemiology, quality of life, and patient care, management, and education are also encouraged. Areas of focus include, but are not limited to, bacterial and fungal infections, viral infections (including HIV/AIDS and hepatitis), parasitological diseases, tuberculosis and other mycobacterial diseases, vaccinations and other interventions, and drug-resistance, chronic infections, epidemiology and tropical, emergent, pediatric, dermal and sexually-transmitted diseases.