Artikel
Routine intraoperative smear testing for microbiological culturing in patients with reoperation due to recurrence after elective degenerative spine surgery – useful or negligible adjunct?
Routinemäßige Entnahme von intraoperartiven Abstrichen zur mikrobiologischen Testung mittels Kultur im Rahmen von Reoperationen aufgrund eines Rezidives degenerativer Wirbelsäulenerkrankungen – sinnvoll oder entbehrlich?
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Autoren
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Sebastian Siller
- University Hospital, Ludwig-Maximilian-University Munich, Neurosurgical Clinic, München, Deutschland
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Benjamin Skrap
- University Hospital, Ludwig-Maximilian-University Munich, Neurosurgical Clinic, München, Deutschland
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Jörg-Christian Tonn
- University Hospital, Ludwig-Maximilian-University Munich, Neurosurgical Clinic, München, Deutschland
| Veröffentlicht: | 4. Juni 2021 |
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Gliederung
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Objective: Subclinical surgical site infections (SSIs) are a rare, but feared reason for a recurrent symptomatology requiring reoperation after degenerative spine surgery. We analyzed a large series of patients to eliducate if routine intraoperative smear testing for microbiological culturing can be an useful adjunct in this situation.
Methods: We investigated the baseline characteristics, imaging/surgical parameters and outcome of patients with reoperation due to recurrence in index segment after elective degenerative spine surgery between 2000 and 2019 in our university neurosurgical clinic. Microbiological cultures via multiple intraoperative smear tests of the superficial and deep wound layers were routinely collected in those patients and correlated with imaging, laboratory and surgical findings for hints of subclinical SSIs.
Results: From altogether 7778 patients with degenerative spine surgery, a total of 488 patients needed reoperation during follow-up accounting for an overall reoperation-rate of 6.3%. Out of these patients, 60 patients underwent reoperation in the index segment due to recurrence of the degenerative pathology without any clinical, imaging or laboratory hints for SSIs. Median age of this patient cohort was 68.5 years, with a predominance of the male sex (m:f=3:2) and the lumbar spine (90%). Mean time between index and re-operation was 18.1±37.2 months. In 11 of the 60 patients (18.3%), microbiological culturing of intraoperative smear testing during reoperation was positive: Minor bacterial growth of Stap. epidermidis, Prop. acnes and Bac. circulans was detected in 5, 4 and 1 patients without any intraoperative surgical hints for infectious findings and classified as “contamination”; none of these patients with watch&wait-strategy developed SSIs or second recurrence during follow-up. Only in a 42-years-old patient with reoperation due to recurrent cervical spinal canal stenosis 3 months after index operation, major bacterial growth of Staph. epidermidis was detected in combination with obvious intraoperative surgical hints for SSI that was immediately and successfully treated with rifampicin and vancomycin.
Conclusion: Routine intraoperative smear testing for microbiological culturing in case of reoperation due to recurrent symptomatology following degenerative spine surgery seems not to be diagnostically useful, unless there are clinical/imaging/laboratory and/or intraoperative surgical hints for SSIs.
