Article
Standard perioperative prophylactic antibiotics are not effective against colonisation of spinal instrumentation and endoprostheses with low-pathogenic bacteria
Die Standard-Antibiotikaprophylaxe ist nicht ausreichend wirksam gegenüber der Kolonisierung von Spondylodesematerial und Endoprothesen mit niedrigvirulenten Bakterien
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Authors
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Ann-Kathrin Jörger
- Technical University Munich, München, Deutschland
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Vicki Butenschoen
- Technical University Munich, München, Deutschland
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Susanne Feihl
- Technical University Munich, München, Deutschland
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Florian Pohlig
- Technical University Munich, München, Deutschland
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Bernhard Meyer
- Technical University Munich, München, Deutschland
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Sandro Krieg
- Technical University Munich, München, Deutschland
| Published: | June 4, 2021 |
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Outline
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Objective: It remains unclear whether low-grade infection of implants is a consequence of bacterial contamination during surgery or if rather these pathogens are intrinsic commensals residing in the deep tissue. The ability of perioperative single-shot antibiotics to eradicate low-virulent bacteria has not been studied sufficiently. In this study we analysed the rates of positive bacterial cultures from removed spinal implants and endoprostheses of hips and knees. The resistance profile of these bacteria with respect to the prophylactic single-shot antibiotics applied during implantation was studied as well.
Methods: A retrospective single-centre study involving two departments was conducted. From January 1st 2018 till March 31st 2020, 94 patients with removal of spinal implants and 448 with removal of hip and knee endoprostheses were included. Patients with spondylodiscitis, deep wound infection, carbon/PEEK implants and acute infection were excluded.
Results: Swabs and sonication of removed spinal implants showed a high rate of positive bacterial cultures not only for patients with screw loosening (43% positive cultures), but also for patients with implants removed because of adjacent segment degeneration (27 %) or after fracture healing (44 %).
Of patients with implant removal because of endoprosthesis loosening in 30% a bacterium was detected. In cases with mechanical failure of endoprostheses without loosening in 13% a bacterium was cultivated.
Most frequent bacteria cultivated were Cutibacterium acnes and Staphylococcus epidermidis. While Cutibacterium acnes was sensitive to the prophylactic antibiotics in all cases, high rates of resistances where found for Staphylococcus epidermidis (45% endoprostheses, 75% spinal implants). When a combination of cefuroxime and vancomycin was used as a prophylactic antibiotic in 23 % a bacterium was detected during implant removal.
Conclusion: Especially for spinal surgery high rates of positive bacterial cultures are found during implant removal for loosened and non-loosened implants. This suggests that low-grade infection as being a major source of implant loosening has to be put in doubt. Moreover, neither standard nor extended perioperative antibiotic regime does prevent colonization of implants with low-pathogenic bacteria.
