Article
Is antiinfective treatment necessary for subclinical bacterial contamination of the surgical site in same-level reoperation due to recurrent degenerative spine disease?
Ist eine antimikrobielle Therapie bei subklinischer bakterieller Verunreinigungen des Operationsgebiets im Rahmen von Reoperationen bei rezidivierender degenerativer Wirbelsäulenerkrankung erforderlich?
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Authors
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Sebastian Siller
- Klinikum der Ludwig-Maximilians-Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland
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Benjamin Skrap
- Klinikum der Ludwig-Maximilians-Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland
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Beatrice Grabein
- Klinikum der Ludwig-Maximilians-Universität München, Institute for Clinical Infectiology and Hospital Hygiene, München, Deutschland
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Jörg-Christian Tonn
- Klinikum der Ludwig-Maximilians-Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland
| Published: | May 25, 2022 |
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Outline
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Objective: Surgical site infections (SSIs) are a dreaded cause for recurrent symptomatology requiring reoperation after degenerative spine surgery. In contrast to clinically obvious SSIs (with e.g. purulent discharge, fever, elevated serum markers and radiological signs of inflammation), subclinical SSIs (with bacterial contamination of the surgical site but without clinical/laboratory/imaging inflammatory response) are still under debate with regard to their best postoperative management.
Methods: In a large single-center cohort of 2552 patients with elective degenerative non-instrumented spine surgery between 2014 and 2019, we selected all patients undergoing reoperation in the previously affected segment due to recurrent symptomatology during follow-up. We analyzed clinical, laboratory and imaging data and routinely performed microbiological cultures via multiple intraoperative smear tests of the surgical site to rule out clinical and subclinical SSIs at the timepoint of reoperation. Outcomes and management of those patients were analyzed and compared to patients with aseptic recurrence of the degenerative spine disease.
Results: A total of 62 patients (m:f=1.6:1, median 69years) underwent same-level reoperation due to recurrent symptomatology (mean ∆-time:17±36months), accounting for a same-segment reoperation-rate during follow-up of 2.4%. 9 of the 62 patients suffered from a clinically obvious SSI demanding an iv- and subsequent po- antiinfective postoperative treatment for a total of 8-12 weeks. In contrast, 53 patients showed no clinical/imaging/laboratory/intraoperative signs for SSI. However, microbiological culturing of smear testing during reoperation showed pathogen growth in 8 of the 53 patients raising suspicion for subclinical SSI respective bacterial contamination of the surgical site; these patients underwent close postoperative surveillance without initiation of an antiinfective treatment. Outcomes of those patients were similar to the 45 patients with aseptic recurrence of the degenerative spine disease in terms of pain reduction (VAS, p=0.990), general performance in daily-life (Barthel-Index, p=0.957), and re-reoperation rate (p=1.000).
Conclusion: Withholding antiinfective treatment in subclinical SSIs with bacterial contamination of the surgical site but without clinical/laboratory/imaging inflammatory response at same-level reoperation after non-instrumented degenerative spine disease is a viable option with unimpaired outcome.
