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Journal of Pediatric Orthopaedics:
doi: 10.1097/BPO.0000000000000252

Management of Late (>1 y) Deep Infection After Spinal Fusion: A Retrospective Cohort Study

Garg, Sumeet MD; LaGreca, Jaren BA; Hotchkiss, Mark BA; Erickson, Mark MD

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Background: The incidence of late infection published in the literature varies from 1% to 12% with varying definition of late infection (range, 3 mo to 1 y). Current evidence suggests implant removal and antibiotic therapy is necessary to clear these infections. A high incidence of late (>1 y) deep infection after instrumented spinal fusion was identified at our institution. We sought to evaluate the efficacy of our management of these patients.

Methods: A total of 1390 patients underwent instrumented spinal fusion from 2000 to 2009. Forty-two patients developed deep infection >1 year after index procedure (3%) and had surgical debridement. Clinical records and microbiology reports were reviewed for details of operative and postoperative management.

Results: Advanced imaging was only obtained in 6 patients (5 computed tomography, 1 magnetic resonance imaging). Offending organisms were identified in 39/42 patients, 27 of these grew Propionibacterium acnes. P. acnes grew in culture at a median of 6 days (range, 3 to 10 d), significantly longer than all other organisms, which grew in a median of 1 day (range, 0 to 8 d) (P<0.001). Implants were removed at the index hospitalization in 41 patients. Implant retention was attempted in 1 patient and failed. Primary closure was carried out in 37 patients; the remainder had undergone multiple debridements (4 planned, 1 unplanned). VAC closure was utilized in 2 patients. All patients were treated with organism-specific intravenous antibiotics and transitioned to oral antibiotics on average in 34 days (range, 2 to 186 d). Total length of antibiotic therapy was an average of 141 days (range, 34 to 413 d).

Conclusions: P. acnes was the most common organism identified and took nearly 1 week to grow in culture. Treatment is generally successful with thorough debridement, removal of implants, and antibiotic treatment.

Level of Evidence: Level III: retrospective comparative study.

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.

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