Propionibacterium acnesinfections in patients with idiopathic scoliosis: a case-control study and review of the literature

PurposeSurgical site infection (SSI) caused by Propionibacterium acnes is an infrequent but devastating complication after spinal fusion. The purpose of this study was to identify risk factors for SSI with Propionibacterium acnes after spinal fusion for juvenile and adolescent idiopathic scoliosis (JIS and AIS).MethodsA case-control study was performed. Each case was matched 2:1 for age, gender and diagnosis. Retrospective chart review was performed to obtain relevant demographic, surgical and clinical data for all cases and controls. Statistical analysis included paired t-test and McNemar test, as well as exact logistic regression and robust regression models.ResultsThis study included ten infection cases (eight AIS, two JIS) and 20 controls (16 AIS, four JIS). In total, six infected cases presented within two weeks of the index procedure (acute infection) and four infected cases presented more than one year from the index procedure (delayed infection). The most common presentation for acute infections was wound drainage, while back pain was more common in delayed infections. All infections were successfully treated with surgical irrigation and debridement and postoperative antibiotics. Hardware was removed for patients with delayed infections. The strongest risk factor for infection was increased requirement for blood transfusion, but it did not reach statistical significance.ConclusionSSI with Propionibacterium acnes is an important complication after spinal fusion for idiopathic scoliosis. These infections can be successfully treated, but larger studies are needed to further identify risk factors and establish standardized guidelines for the treatment and prevention of this complication.Level of Evidence Level III

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Risk Factors for Surgical Site Infections Following Spinal Fusion Procedures: A Case-Control Study

Yearbook of Orthopedics ◽

10.1016/j.yort.2012.05.030 ◽

2012 ◽

Vol 2012 ◽

pp. 344-345

Author(s):

P. Huddleston

Keyword(s):

Risk Factors ◽

Spinal Fusion ◽

Case Control Study ◽

Surgical Site Infections ◽

Case Control ◽

Control Study

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Physical activities of Patients with adolescent idiopathic scoliosis (AIS): preliminary longitudinal case–control study historical evaluation of possible risk factors

Scoliosis ◽

10.1186/s13013-015-0029-8 ◽

2015 ◽

Vol 10 (1) ◽

Cited By ~ 11

Author(s):

Marianne E McMaster ◽

Amanda Jane Lee ◽

R Geoffrey Burwell

Keyword(s):

Risk Factors ◽

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Case Control Study ◽

Case Control ◽

Physical Activities ◽

Control Study

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Risk Factors for Surgical Site Infections Following Neurosurgical Spinal Fusion Operations: A Case Control Study

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2016.307 ◽

2016 ◽

Vol 38 (3) ◽

pp. 340-347 ◽

Cited By ~ 7

Author(s):

Thomas L. Walsh ◽

Ashley M. Querry ◽

Sheila McCool ◽

Alison L. Galdys ◽

Kathleen A. Shutt ◽

...

Keyword(s):

Risk Factors ◽

Spinal Fusion ◽

Protective Factor ◽

Case Control Study ◽

Care Center ◽

Surgical Site Infections ◽

Case Control ◽

Study Cohort ◽

Retrospective Case ◽

Control Study

OBJECTIVETo determine risk factors for the development of surgical site infections (SSIs) in neurosurgery patients undergoing spinal fusion.DESIGNRetrospective case-control study.SETTINGLarge, academic, quaternary care center.PATIENTSThe study population included all neurosurgery patients who underwent spinal fusion between August 1, 2009, and August 31, 2013. Cases were defined as patients in the study cohort who developed an SSI. Controls were patients in the study cohort who did not develop an SSI.METHODSTo achieve 80% power with an ability to detect an odds ratio (OR) of 2, we performed an unmatched case-control study with equal numbers of cases and controls.RESULTSDuring the study period, 5,473 spinal fusion procedures were performed by neurosurgeons in our hospital. With 161 SSIs recorded during the study period, the incidence of SSIs associated with these procedures was 2.94%. While anterior surgical approach was found to be a protective factor (OR, 0.20; 95% confidence interval [CI], 0.08–0.52), duration of procedure (OR, 1.58; 95% CI, 1.29–1.93), American Society of Anesthesiologists score of 3 or 4 (OR, 1.79; 95% CI, 1.00–3.18), and hospitalization within the prior 30 days (OR, 5.8; 95% CI, 1.37–24.57) were found in multivariate analysis to be independent predictors of SSI following spinal fusion. Prior methicillin-resistant Staphylococcus aureus (MRSA) nares colonization was highly associated with odds 20 times higher of SSI following spinal fusion (OR, 20.30; 95% CI, 4.64–8.78).CONCLUSIONSIn additional to nonmodifiable risk factors, prior colonization with MRSA is a modifiable risk factor very strongly associated with development of SSI following spinal fusion.Infect Control Hosp Epidemiol 2017;38:348–352

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Surgical-Site Infection Following Spinal Fusion: A Case-Control Study in a Children's Hospital

Infection Control and Hospital Epidemiology ◽

10.1086/502259 ◽

2003 ◽

Vol 24 (8) ◽

pp. 591-595 ◽

Cited By ~ 57

Author(s):

Annie-Claude Labbé ◽

Anne-Marie Demers ◽

Ramona Rodrigues ◽

Vincent Arlet ◽

Kim Tanguay ◽

...

Keyword(s):

Risk Factors ◽

Antibiotic Prophylaxis ◽

Spinal Fusion ◽

Spinal Surgery ◽

Case Control Study ◽

Tertiary Care ◽

Surgical Site Infections ◽

Case Control ◽

Gram Negative Organisms ◽

Control Study

AbstractObjectives:To determine the rates of surgical-site infections (SSIs) after spinal surgery and to identify the risk factors associated with infection.Design:SSIs had been identified by active prospective surveillance. A case-control study to identify risk factors was performed retrospectively.Setting:University-associated, tertiary-care pediatric hospital.Patients:All patients who underwent spinal surgery between 1994 and 1998. Cases were all patients who developed an SSI after spinal surgery. Controls were patients who did not develop an SSI, matched with the cases for the presence or absence of myelodysplasia and for the surgery date closest to that of the case.Results:There were 10 infections following 125 posterior spinal fusions, 4 infections after 50 combined anterior-posterior fusions, and none after 95 other operations. The infection rate was higher in patients with myelodysplasia (32 per 100 operations) than in other patients (3.4 per 100 operations; relative risk = 9.45; P < .001). Gram-negative organisms were more common in early infections and Staphylococcus aureus in later infections. Most infections occurred in fusion involving sacral vertebrae (odds ratio [OR] = 12.0; P = .019). Antibiotic prophylaxis was more frequently suboptimal in cases than in controls (OR = 5.5; P = .034). Five patients required removal of instrumentation and 4 others required surgical debridement.Conclusions:Patients with myelodysplasia are at a higher risk for SSIs after spinal fusion. Optimal antibiotic prophylaxis may reduce the risk of infection, especially in high-risk patients such as those with myelodysplasia or those undergoing fusion involving the sacral area.

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