Deep wound infection following pediatric scoliosis surgery: incidence and analysis of risk factors

Abstract Background and Study Aims The treatment of infections following a spine surgery continues to be a challenge. Negative pressure wound therapy (NPWT) has been an effective method in the context of infection therapy, and its use has gained popularity in recent decades. This study aims to analyze the impact of known risk factors for postoperative wound infection on the efficiency and length of NPWT therapy until healing. Patients and Methods We analyzed 50 cases of NPWT treatment for deep wound infection after posterior and posteroanterior spinal fusion from March 2010 to July 2014 retrospectively. We included 32 women and 18 men with a mean age of 69 years (range, 36–87 years). Individual risk factors for postoperative infection, such as age, gender, obesity, diabetes, immunosuppression, duration of surgery, intraoperative blood loss, and previous surgeries, as well as type and onset (early vs. late) of the infection were analyzed. We assessed the associations between these risk factors and the number of revisions until wound healing. Results In 42 patients (84%), bacterial pathogens were successfully detected by means of intraoperative swabs and tissue samples during first revision. A total of 19 different pathogens could be identified with a preponderance of Staphylococcus epidermidis (21.4%) and S. aureus (19.0%). Methicillin-resistant S. aureus (MRSA) was recorded in two patients (2.6%). An average of four NPWT revisions was required until the infection was cured. Patients with infections caused by mixed pathogens required a significantly higher number of revisions (5.3 vs. 3.3; p < 0.01) until definitive wound healing. For the risk factors, no significant differences in the number of revisions could be demonstrated when compared with the patients without the respective risk factor. Conclusion NPWT was an effective therapy for the treatment of wound infections after spinal fusion. All patients in the study had their infections successfully cured, and all spinal implants could be retained. The number of revisions was similar to those reported in the published literature. The present study provides insights regarding the effectiveness of NPWT for the treatment of deep wound infection after spinal fusion. Further investigations on the impact of potential risk factors for postoperative wound healing disorders are required. Better knowledge on the impact of specific risk factors will contribute to a higher effectiveness of prophylaxis for postoperative wound infections considering the patient-specific situation.

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AN APPROACH FOR MEDIASTINITIS PREVENTIONIN PATIENTS FOLLOWING CARDIAC SURGERY

HERALD of North-Western State Medical University named after I I Mechnikov ◽

10.17816/mechnikov20157438-42 ◽

2015 ◽

Vol 7 (4) ◽

pp. 38-42 ◽

Cited By ~ 1

Author(s):

A V Sotnikov ◽

V M Melnikov ◽

R V Almadi ◽

G N Gorbunov

Keyword(s):

Cardiac Surgery ◽

Wound Infection ◽

Incidence Rate ◽

Control Group ◽

Study Group ◽

Intravenous Injections ◽

Deep Wound Infection ◽

Period 2 ◽

Deep Wound

The aim of this study was to reduce incidence of sternal deep wound infection (DWI) in patients following cardiac surgery. An experience of cardiac surgery by sternotomy access in 429 consecutive patients was presented. Perioperative intravenous injections of cefazolin were used in 225 patients (control group). Combination of perioperative intravenous injections with local retrosternal irrigation of cefazolin before sternum closure was used in 204 patients (study group). In control group sternal DWI occurred in 10 patients (4.4%), and in 4 patients a resternotomy sanation required. There were no deaths in this group due to infection or sepsis. In follow-up period (3 years), instability of sternum occurred in 3 patients (1.3%), and in 1 (0.4%) sternum reosteosynthesis required. In studied group the sternal DWI did not occur (p<0.01). Sternum instability and/or indications for sternum reosteosynthesis were not determined in follow-up period (2 years). It was concluded, that combination of intravenous and local usage of cefazolin in cardiac surgery patients is a simple and effective approach to prevent sternal DWI. Application of this method significantly (p<0.01) reduces the incidence rate of mediastinitis.

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Effective Protocol to Treat Patients with Deep Wound Infection after Spinal Lumbar Fusion

Global Spine Journal ◽

10.1055/s-0035-1554547 ◽

2015 ◽

Vol 5 (1_suppl) ◽

pp. s-0035-1554547-s-0035-1554547

Author(s):

Asdrubal Falavigna ◽

Orlando Righesso ◽

Alisson Roberto Teles ◽

Pedro Guarise da Silva ◽

Francisco Bassanesi

Keyword(s):

Wound Infection ◽

Lumbar Fusion ◽

Deep Wound Infection ◽

Deep Wound

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Deep wound infection after proximal femoral fracture: consequences and costs

Journal of Hospital Infection ◽

10.1016/j.jhin.2006.01.015 ◽

2006 ◽

Vol 63 (2) ◽

pp. 133-139 ◽

Cited By ~ 63

Author(s):

T.C.B. Pollard ◽

J.E. Newman ◽

N.J. Barlow ◽

J.D. Price ◽

K.M. Willett

Keyword(s):

Wound Infection ◽

Femoral Fracture ◽

Proximal Femoral Fracture ◽

Deep Wound Infection ◽

Deep Wound

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Wide variation in risk of wound infection following clean neurosurgery

Journal of Neurosurgery ◽

10.3171/jns.1985.62.2.0243 ◽

1985 ◽

Vol 62 (2) ◽

pp. 243-247 ◽

Cited By ~ 135

Author(s):

James H. Tenney ◽

David Vlahov ◽

Michael Salcman ◽

Thomas B. Ducker

Keyword(s):

Wound Infection ◽

Wound Infection Rate ◽

Neurosurgical Procedures ◽

Postoperative Wound Infection ◽

Content Type ◽

Postoperative Wound ◽

Deep Wound Infection ◽

Deep Wound ◽

Potential Efficacy ◽

Perioperative Antibiotics

✓ The authors have prospectively examined the occurrence of postoperative wound infection following clean neurosurgery in 936 patients. Fewer than 1% received perioperative antibiotic prophylaxis. The overall rate of deep wound infection was 2.6%; no deaths were directly attributable to these infections. Deep wound infections occurred significantly more frequently following craniotomy (4.3%) than following spinal (0.9%) or other clean neurosurgery. Among craniotomies, the deep wound infection rate varied significantly from 11% following repeat operations for recurrent gliomas to 2.5% following non-tumor surgery. Risk of deep wound infection varied more than 11-fold depending on the type of clean neurosurgical operation. It is most feasible to demonstrate the potential efficacy of perioperative antibiotics in clean neurosurgical procedures with the greatest risk of postoperative wound infection. The potential benefit from such prophylaxis would be greatest for patients undergoing these high-risk operations.

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Comparison of Deep Wound Infection Rates Using a Synthetic Dural Substitute (Neuro-Patch) or Pericranium Graft for Dural Closure: A Clinical Review of 1 Year

Neurosurgery ◽

10.1227/01.neu.0000108640.45371.1a ◽

2004 ◽

Vol 54 (3) ◽

pp. 599-604 ◽

Cited By ~ 75

Author(s):

Miriam Malliti ◽

Philippe Page ◽

Charles Gury ◽

Eric Chomette ◽

François Nataf ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Wound Infection ◽

The Body ◽

Infection Rates ◽

Septic Complications ◽

Dural Closure ◽

Deep Wound Infection ◽

Deep Wound ◽

Clinical Series ◽

Duration Of Surgery

Abstract OBJECTIVE The need to repair dural defects has prompted the use of dura mater substitutes. Many synthetic materials have been used for dural closure. Neuro-Patch (B. Braun Médical S.A., Boulogne, France) is a nonabsorbable microporous fleece composed of polyester urethane that has been approved for human use by the European Union since 1995. To the best of our knowledge, no clinical series with Neuro-Patch have been published thus far, particularly with regard to septic complications. The aim of our study was to compare the safety of Neuro-Patch with that of pericranium graft with regard to postoperative wound infections. METHODS This is a retrospective study of 1 year's experience including all patients who underwent dural plasty with a Neuro-Patch (n = 61) or pericranium graft (n = 63). The follow-up period was at least 12 months after surgery. Before wound infection rates in the two groups were compared, factors suspected of being risks for neurosurgical site infection were evaluated. RESULTS Patient characteristics (mean age, neurological diagnosis), surgical procedures, prophylactic antibiotics, and risk factors for surgical infections (including duration of surgery, emergency, contaminated operations, and external cerebrospinal fluid drainage) were similar in the Neuro-Patch and pericranium groups. Deep wound infection rates in the Neuro-Patch and pericranium groups were 15 and 5%, respectively (P = 0.06), and cerebrospinal fluid leaks were significantly more frequent in the Neuro-Patch group (13 versus 1.6%, P < 0.05). CONCLUSION The results of our investigations show that Neuro-Patch raised the risk of wound infection, as do foreign materials implanted in the body. Synthetic dural grafts should be reserved for when autologous grafts are not sufficient or possible. An extensive prospective multicenter randomized trial is needed to confirm our results.

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