Abstract：
BACKGROUND: Spinal instrumentation-related infections (SIRI) are one of the main causes of post-surgical complication and comorbidity. Our objective was to describe the clinical and microbiological characteristics, treatment and prognosis of these infections.
METHODS: We conducted a retrospective study in our institution (2011-2018) including adult patients undergoing spinal instrumentation who met the diagnostic criteria for confirmed infection. Superficial surgical wound and deep intraoperative samples were processed for microbiological culture. The medical and orthopaedic team was always the same.
RESULTS: Forty-one cases were diagnosed of which 39 patients (95.1%) presented early infection (<3 months after initial surgery) with symptoms in the first two weeks, mean CRP at diagnosis was 133mg/dl and 23% associated bacteremia. The remaining two patients (4.8%) were chronic infections (symptoms >3 months after surgery). The treatment of choice in early infections was the Debridement, Antibiotics and Implant Retention (DAIR) strategy without removal of the bone graft, which successfully resolved 84.2% of the infections. The main aetiology was gram-positive (Staphylococcus aureus: 31.7%), followed by gram-negative and polymicrobial flora. Antibiotics were optimised according to cultures with a mean duration of 12 weeks.
CONCLUSIONS: In early infections, early diagnosis and DAIR strategy (with bone graft retention) demonstrated a healing rate higher than 80%.
METHODS: We conducted a retrospective study in our institution (2011-2018) including adult patients undergoing spinal instrumentation who met the diagnostic criteria for confirmed infection. Superficial surgical wound and deep intraoperative samples were processed for microbiological culture. The medical and orthopaedic team was always the same.
RESULTS: Forty-one cases were diagnosed of which 39 patients (95.1%) presented early infection (<3 months after initial surgery) with symptoms in the first two weeks, mean CRP at diagnosis was 133mg/dl and 23% associated bacteremia. The remaining two patients (4.8%) were chronic infections (symptoms >3 months after surgery). The treatment of choice in early infections was the Debridement, Antibiotics and Implant Retention (DAIR) strategy without removal of the bone graft, which successfully resolved 84.2% of the infections. The main aetiology was gram-positive (Staphylococcus aureus: 31.7%), followed by gram-negative and polymicrobial flora. Antibiotics were optimised according to cultures with a mean duration of 12 weeks.
CONCLUSIONS: In early infections, early diagnosis and DAIR strategy (with bone graft retention) demonstrated a healing rate higher than 80%.
摘要：
背景：脊柱器械相关感染（SIRI）是术后并发症和合并症的主要原因之一。我们的目的是描述临床和微生物学特征，这些感染的治疗和预后。
方法：我们在我们机构（2011-2018年）进行了一项回顾性研究，包括接受脊柱器械治疗且符合确诊感染诊断标准的成年患者。对表面手术伤口和深部术中样品进行微生物培养。医疗和骨科团队总是一样。
结果：41例确诊，其中39例患者（95.1%）在最初两周出现早期感染（初次手术后<3个月）症状，诊断时的平均CRP为133mg/dl,相关菌血症为23%.其余2例(4.8%)为慢性感染(术后症状>3个月)。早期感染的治疗选择是清创术，抗生素和植入物保留（DAIR）策略，不去除骨移植物，成功解决了84.2%的感染。主要病因为革兰阳性(金黄色葡萄球菌:31.7%),其次是革兰氏阴性和多微生物菌群。根据培养物优化抗生素,平均持续时间为12周。
结论：在早期感染中，早期诊断和DAIR策略(伴植骨保留)显示治愈率高于80%.
方法：我们在我们机构（2011-2018年）进行了一项回顾性研究，包括接受脊柱器械治疗且符合确诊感染诊断标准的成年患者。对表面手术伤口和深部术中样品进行微生物培养。医疗和骨科团队总是一样。
结果：41例确诊，其中39例患者（95.1%）在最初两周出现早期感染（初次手术后<3个月）症状，诊断时的平均CRP为133mg/dl,相关菌血症为23%.其余2例(4.8%)为慢性感染(术后症状>3个月)。早期感染的治疗选择是清创术，抗生素和植入物保留（DAIR）策略，不去除骨移植物，成功解决了84.2%的感染。主要病因为革兰阳性(金黄色葡萄球菌:31.7%),其次是革兰氏阴性和多微生物菌群。根据培养物优化抗生素,平均持续时间为12周。
结论：在早期感染中，早期诊断和DAIR策略(伴植骨保留)显示治愈率高于80%.
