Artikel
Unexpected positive cultures in presumed aseptic revision spine surgery using sonication
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Veröffentlicht: | 22. Oktober 2019 |
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Gliederung
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Objectives: During revision procedures for aseptic reasons, there is always suspicion that failure may have been the result of an undetected subclinical infection. However there is little evidence available in literature about unexpected positive results in presumed aseptic revision spine surgery. The aims of our study were to estimate the prevalence of unexpected positive culture using sonication and evaluate clinical characteristics of these patients.
Methods: All patients, who underwent a revision surgery after instrumented spinal surgery at our institution between 07/2014 and 08/2016 with spinal implants submitted for sonication, were retrospectively analyzed. Only revisions presumed as aseptic are included in the study.
Results and conclusion: Sonication cultures were obtained in 166 cases and were positive in 75 cases (45.2%). Hardware failure (26/75 cases, 35%) was the most common revision surgical diagnosis in the setting of positive sonication culture followed by adjacent segment disease (ASD) (23/75 cases, 30%). Propionibacterium acnes and Staphylococcus epidermidis were the most commonly isolated microorganisms, observed in 45% and 31% of cases, respectively. Propionibacterium acnes was isolated in 65.2% of cases with the primary diagnosis of adjacent segment disease. Infection must always be entertained as a possibility in the setting of spinal revision surgery, especially in case of hardware failure regardless of the lack of clinical signs. Sonication should be routinely used to isolate microorganisms adherent to implants.