Posterior spinal postsurgical infection: infection, obesity and transferring to ICU as independent risk factors

doi:10.3969/j.issn.2095-4344.2015.07.026

Abstract

Abstract:

BACKGROUND: With the application of new screw-rod system, fusion cage and minimally invasive techniques, the amount of spinal surgeries becomes gradually increasing, along with expanded surgical scope and increased surgical difficulty. Meanwhile, postoperative infection rate is also increasing. Postoperative infections after spinal surgery often lead to increased length of stay and hospital costs, and cause neurological deterioration, and even death.

OBJECTIVE: To investigate the risk factors and treatment strategies of posterior spinal postoperative infections.

METHODS: A retrospective analysis including 857 cases of posterior spinal surgery from September 2012 to September 2013 in the Department of Spinal Surgery, the First Affiliated Hospital of Xinjiang Medical University was performed. These patients were divided into infection (n=34) and non-infection (n=823) groups. We compared the preoperative, intraoperative, postoperative factors affecting postoperative infection in the two groups, and summarized the therapeutic strategies by analyzing the treatment methods and therapeutic effects.
RESULTS AND CONCLUSION: The infection rate after posterior spinal surgery was 3.97% (34/857). There were significantly differences between the two groups in terms of muscle strength ≤ 3 level, preoperative immune dysfunction, acute or chronic infection, obesity, preoperative and postoperative incontinence or catheterization time≥ 3 days, operative time ≥180 minutes, intraoperative bleeding, allogeneic bone grafting, standard use of antibiotics, postsurgical transferring to ICU, the number of drainage pipes, and the time of indwelling drainage tube (P < 0.05), while other variables showed no statistical significance. Logistic regression analysis showed that acute or chronic infections, obesity (bone mass index > 30 kg/m²), transfering to ICU after surgery were independent risk factors for posterior spinal postoperative infections. In addition, individual treatment is preferred for different patients with posterior spinal postoperative infections. It is even more important to choose the appropriate treatment.

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

全文链接：

Key words: Spine, Internal Fixators, Infection, Risk Factors

CLC Number:

R318

Na Sen, Xu Tao, Guo Hai-long, Sheng Wei-bin. Posterior spinal postsurgical infection: infection, obesity and transferring to ICU as independent risk factors[J]. Chinese Journal of Tissue Engineering Research, 2015, 19(7): 1127-1132.

Figures/Tables 5

术前及术后尿便失禁或留置导尿时间≥3 d、术后转入ICU、引流管根数、留置引流管天数在两组间差异有显著性意义(P < 0.05)。 2.6 影响脊柱术后感染的多因素分析将有统计学意义的变量(肌力、术前免疫功能减退、急慢性感染、既往脊柱手术史、术前及术后尿便失禁或留置导尿时间≥3 d、肥胖、手术时间、出血量、输血、植异体骨、抗生素、术后转入ICU、引流管根数、留置引流管天数)放入多因素Logistic回归模型，确定急性慢性感染、肥胖、术后转入ICU为脊柱术后感染的独立危险因素，见表4。 2.7 脊柱术后感染的治疗伤口分泌物细菌培养：14例呈阳性结果，其中金黄色葡萄球菌3例，大肠埃希菌2例，表皮葡萄球菌、阴沟肠杆菌、模仿葡萄球菌、铜绿假单胞菌、鲍曼不动杆菌、肺炎克雷伯杆菌、溶血性葡萄球菌、混合感染各1例，另20例培养无细菌生长。34例患者中，33例感染获得治愈，1例死亡。处理方式：本组中34例脊柱术后感染患者的伤口处理分为两类。 12例采用保守治疗：感染部位局部拆线，清除坏死物质，加以换药冲洗及静脉注射敏感抗生素，以达到治愈目的。 22例患者行全麻清创手术治疗，其中9例清创术后留置负压引流管，另外13例采用术后对口置管冲洗引流，即清创后于伤口两端分别放置冲洗管和引流管，生理盐水持续冲洗。待冲洗液清澈、患者红肿热痛等感染症状好转后，隔天送培养，连续3次无细菌生长后可拔除冲洗管，保留引流管并改为负压，待引流量极少时，向切口内注射敏感抗生素后拔除引流管；22例均根据细菌培养使用敏感抗生素。治疗结果：单纯伤口冲洗、换药所需愈合时间平均24 d。而伤口对口置管冲洗引流所需时间平均15 d，患者因感染住院时间缩短。 1例由于患者肺栓塞，抢救无效死亡。清创术中内固定取出3例，1例内固定已发生松动，2例在清创过程中发现内固定周围污染较为严重。"

References

[1]Antoine G,Juan CRO,Fabian B.Infections in spinal instrumentation. Int Orthop(SICOT). 2012;36:457-464.
[2]Manish K,Kasliwal, Lee A. Infection with spinal instrumentation: Review of pathogenesis, diagnosis, prevention, and management. Surg Neurol Int. 2013;4: S392-403.
[3]Zucherman J, Hsu K, White A, et al. Early results of spinal fusion using variable spine plating system. Spine. 1988; 13: 570-579.
[4]Amy M, Michael J, Brook I, et al. Using the Spine Surgical Invasiveness Index to Identify Risk of Surgical Site Infection. J Bone Joint Surg. 2012;94:335-342.
[5]Olsen MA, Nepple JJ, Riew KD, et al. Risk factors for surgical site infection following orthopaedic spinal operations. J Bone Joint Surg Am. 2008;90(1):62-69.
[6]缪锦浩,陈德玉.脊柱手术后切口感染的危险因素.[J].中国脊柱脊髓杂志,2010,20(3):246-247.
[7]Abdul-Jabbar , Amir BA ,Takemoto S, et al. Surgical site infection in spinal surgery. Spine. 2012;37(15):1340-1345.
[8]Bobby DK, Wellington KH, Gildasio S, et al. Operative Duration as an Independent Risk Factor for Postoperative Complications in Single-Level Lumbar Fusion. Spine. 2014; 39(6):510-520.
[9]Murphy GJ, Reeves BC, Rogers CA, et al. Increased mortality,postoperative morbidity, and cost after red blood cell transfusion in patients having cardiac surgery. Cardiovas Surg. 2007;116(22):2544-2552.
[10]Maragakis LL, Cosgrove SE, Martinez EA, et al. Intraoperative fraction of inspired oxygen is a modifiable risk factor for suigical site infection after spinal surgery. Anesthesiology. 2009;110(3):556-562.
[11]Schimmel JP, Horsting PP, Kleuver M, et al. Risk factors for deep surgical site infections after spinal fusion. Eur Spine J. 2010;19:1711-1719.
[12]Linam WM, Margolis PA, Staat MA, et al. Risk factors associated with surgical site infection after pediatric posterior spinal fusion procedure. Infect Control Hosp Epidemiol. 2009;30(2):109-116.
[13]Kaisorn L, Bydon M, David R. Risk of infection following posterior instrumented lumbar fusion for degenerative spine disease in 817 consecutive cases.J Neurosurg Spine. 2014; 20:45-52.
[14]刘少强,齐强陈,陈仲强,等.腰椎术后感染的危险因素及合理防治[J].中华外科杂志,2013,51(12):1128-1131.
[15]熊敏,应文娟.重症监护室医院感染监测及对策[J].中华医院感染学杂志,2005,15(4):447．
[16]Xing D,Ma JX, Ma XL,et al. A methodological, systematic review of evidence-based independent risk factors for surgical site infections after spinal surgery. Eur Spine J. 2013; 22:605-615.
[17]Strom RG, Pacione D, Kalhorn SP, et al. Decreased Risk of Wound Infection After Posterior Cervical Fusion With Routine Local Application of Vancomycin Powder. Spine. 2013;38(12): 991-994.
[18]Hegde V, Meredith DS, Christopher K, et al. Management of postoperative spinal infections. World J Orthop. 2012;3(11): 182-189.
[19]田耘,陈仲强,刘忠军,等.脊柱术后伤口深部感染的处理[J].中华外科杂志,2005,43(4):229-231.
[20]Hong HS, Chang MC, Liu CL, et al. Is aggressive surgery necessary for acute postoperative deep spinal wound infection. Spine. 2008;33:2473-2478 .
[21]Mok JM, Guillaume TJ, Talu U, et al. Clinical outcome of deep wound infection after instrumented posterior spinal fusion: a matched cohort analysis. Spine. 2009;34:578-583.
[22]Jahoda D, Nyc O, Pokorny D, et al. Antibiotic treatment for prevention of infectious complications in joint replacement. Acta Chir Orthop Traumatol Cech. 2006;73(2):108-114.
[23]Barnes M, Liew S. The Incidence of Infection after Posterior Cervical Spine Surgery: A 10 Year Review. Global Spine J. 2012;2:3-6.
[24]Martin JR, Adogwa O, Brown CR, et al. Experience With Intrawound Vancomycin Powder for Spinal Deformity Surgery. Spine. 2013;39(2):177-184.
[25]Fang XT, Wood KB. Management of postoperative instrumented spinal wound infection. Chin Med J (Engl). 2013; 126(20):3817-3821.
[26]Andrew J , Leah M , Julia O, et al. Risk Factors for Immediate Postoperative Complications and Mortality Following Spine Surgery: A Study of 3475 Patients from the National Surgical Quality Improvement Program.. J Bone Joint Surg Am. 2011; 93:1-7.
[27]陈鹏,陈刚,朱国兴,等.腰椎术后感染的原因分析与治疗策略[J]. 临床骨科杂,2013,16(5):506-509.
[28]张明德,朱俊峰.全髋关节置换术后感染的危险因素分析及早期诊断[J].重庆医学,2013:42(33):3999-4003.
[29]王荣强.脊柱手术后并发感染的原因及处理[J].中国实用医药, 2014:9(3):79-80.
[30]马振江,赵杰,娄伟刚,等.脊柱手术部位感染的危险因素及预防措施研究进展[J].中国脊柱脊髓杂志,2014, 24(3):279-283.