Postoperative spine infections

Postoperative spinal wound infection is a potentially devastating complication after operative spinal procedures. Despite the utilization of perioperative prophylactic antibiotics in recent years and improvements in surgical technique and postoperative care, wound infection continues to compromise patients’ outcome after spinal surgery. In the modern era of pending health care reform with increasing financial constraints, the financial burden of post-operative spinal infections also deserves consideration. The aim of our work is to give to the reader an updated review of the latest achievements in prevention, risk factors, diagnosis, microbiology and treatment of post-operative spinal wound infections. A review of the scientific literature was carried out using electronic medical databases Pubmed, Google Scholar, Web of Science and Scopus for the years 1973-2012 to obtain access to all publications involving the incidence, risk factors, prevention, diagnosis, treatment of postoperative spinal wound infections. We initially identified 119 studies; of these 60 were selected. Despite all the measures intended to reduce the incidence of surgical site infections in spine surgery, these remain a common and potentially dangerous complication.

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Management of Deep Spinal Wound Infections Following Instrumentation Surgery with Subfascial Negative Pressure Wound Therapy

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0040-1720999 ◽

2021 ◽

Author(s):

Marcus Rickert ◽

Michael Rauschmann ◽

Nizar Latif-Richter ◽

Mohammad Arabmotlagh ◽

Tamin Rahim ◽

...

Keyword(s):

Risk Factors ◽

Wound Healing ◽

Wound Infection ◽

Spinal Fusion ◽

Negative Pressure Wound Therapy ◽

Wound Infections ◽

Wound Therapy ◽

Postoperative Wound ◽

Deep Wound ◽

The Impact

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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Incidence, Risk Factors and Etiology of Surgical Site Infections in a Tertiary Care Hospital

International Journal of Current Research and Review ◽

10.31782/ijcrr.2021.sp258 ◽

2021 ◽

pp. 154-159

Author(s):

Das SK ◽

Panigrahy R ◽

Jain S ◽

Baral P

Keyword(s):

Risk Factors ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Surgical Site Infections ◽

Care Hospital ◽

Incidence Risk

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Identification and Management of Lymphedema in Patients With Breast Cancer

Journal of Oncology Practice ◽

10.1200/jop.18.00141 ◽

2019 ◽

Vol 15 (5) ◽

pp. 255-262 ◽

Cited By ~ 2

Author(s):

Pavankumar Tandra ◽

Avyakta Kallam ◽

Jairam Krishnamurthy

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Cancer Treatment ◽

Early Stage ◽

Financial Burden ◽

Breast Cancer Treatment ◽

Initial Diagnosis ◽

Axillary Surgery ◽

Incidence Risk ◽

End Stage

Breast cancer–related lymphedema (BCRL) is a potentially debilitating and often irreversible complication of breast cancer treatment. Risk of BCRL is proportional to the extent of axillary surgery and radiation. Other risk factors include obesity and infections. Given the 5-year survival rate of 90% and its potential impact on the quality of life of survivors of breast cancer, BCRL has become a significant financial burden on the health care system. Minimizing axillary surgery and radiation has been proven to reduce the risk of BCRL. Comprehensive multidisciplinary assessment at the time of initial diagnosis; early referral to physical therapy after surgery; and patient education regarding weight loss, skin, and nail care are cornerstones of the management of early-stage lymphedema. End-stage lymphedema may benefit from referral to a plastic surgeon specializing in lymphedema surgery. In this review, we attempt to review the incidence, risk factors, staging, prevention, and management of this complication of breast cancer treatment. We also describe our multidisciplinary approach for the prevention of this complication at the time of initial diagnosis.

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Incidence, risk factors and etiological agents in surgical site infections in a developing country

BMC Proceedings ◽

10.1186/1753-6561-5-s6-p194 ◽

2011 ◽

Vol 5 (S6) ◽

Author(s):

E Alp ◽

F Elmali ◽

S Ersoy ◽

C Kucuk ◽

B Tucer ◽

...

Keyword(s):

Risk Factors ◽

Developing Country ◽

Surgical Site Infections ◽

Incidence Risk ◽

Etiological Agents

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Evaluation of Pre-Operative Risk Factors for Post-Surgical Wound Infection in Elective Operation

Ibrahim Cardiac Medical Journal ◽

10.3329/icmj.v5i1-2.53697 ◽

2017 ◽

Vol 5 (1-2) ◽

pp. 15-20

Author(s):

Md Shahidul Islam ◽

Mitheel Ibna Islam ◽

Md Jamal Saleh Uddin ◽

Abul Kalam Md Faruq ◽

Samar Chandra Saha ◽

...

Keyword(s):

Risk Factors ◽

Wound Infection ◽

Surgical Site Infections ◽

Final Analysis ◽

Urinary Stones ◽

Diabetic Patients ◽

College Hospital ◽

Cross Sectional ◽

Elective Operation ◽

Operative Wound

Background & Objective: Postoperative surgical site infections (SSIs) are still among the most common serious complications of surgery in terms of cost and consequences. Different risk factors like age, sex, nutrition, immunity, operation type, duration of stay in hospital and presence of hair on the skin may involve with SSIs. This study was intended to determine the risk factors for surgical site infections in a tertiary level hospital. Methods: This Cross Sectional observational study was carried out in the Department of Surgery, Rajshahi Medical College Hospital, Rajshahi, over a period of 12 months from May 2009 to April 2010. A total of 232 patients (aged 18 years onwards) of either sex scheduled for elective operation were included in the study. Common indications for operation were chronic calculus cholecystitis, stoma in situ, inguinal hernia, renal/urinary stones and benign prostatic hyperplasia and so on. As two patients were discharged on request on 2nd postoperative day, 230 patients were left for final analysis. The patients were followed till discharge. Results: Of the total 230 patients, 21(9.1%) developed post-operative wound infection. The incidence of wound infection was significantly higher in older patients (p = 0.014). However sex did not have any influence on wound infection. The malnourished patients (underweight in terms of BMI) developed SSIs more frequently than their normal or overweight counterparts (p < 0.001). Diabetic patients developed post-operative wound infection more often than the non-diabetics(p = 0.072). The incidence of post-operative wound infection was not found to be associated with shaving of hair on the skin over the operative site (p = 0.378). Contaminated wounds encountered SSI significantly more than the clean wounds did (p = 0.001). Conclusion: The study concluded that one in every ten patients undergoing abdominal surgery may develop postoperative wound infection and factors commonly associated with wound infection are older age, underweight, diabetes, contaminated wound, longer preoperative and postoperative hospital stay. The study suggests that reducing the factors of SSI (as far as practicable) will reduce the incidence of SSI. Ibrahim Card Med J 2015; 5 (1&2): 15-20

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Surveillance of surgical site infections to determine incidence, risk factors and microbiologic spectrum following obstetric and gynaecological surgeries

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20184124 ◽

2018 ◽

Vol 7 (10) ◽

pp. 4029

Author(s):

Seetha Panicker ◽

T. V. Chitra

Keyword(s):

Risk Factors ◽

Operating Time ◽

Surgical Site Infections ◽

Multidrug Resistant ◽

E Coli ◽

Incidence Risk ◽

Resistant Strains ◽

Prolonged Hospital ◽

Drug Resistant Strains ◽

Hospital Acquired

Background: Surgical site infections (SSI) are one of the major health problems throughout the world with an incidence of 3%-16%. Hospital acquired surgical site infection is further complicated by the emergence of multi drug resistant strains. SSI surveillance is an established monitoring tool and has been shown to reduce infection rates. The importance of preventing surgical site infections is well recognized since they lead to increased morbidity, prolonged hospital stay, need for readmission, high end antibiotic treatment and re-surgery. This study was undertaken to determine the incidence, risk factors, and microbiological spectrum of surgical site infections and to identify the multidrug resistant strains. Analysis of the effectiveness of the existing surveillance methods was also done.Methods: This retrospective study was done for a period of 1-year form Jan 2016 to Dec 2016. All patients with infection following caesarean section and abdominal and vaginal hysterectomy were included. Laparoscopic surgery and patients with preexisting infection were excluded.Results: Incidence of SSI in present study is 5.27%. The major risk factors identified were obesity, diabetes and prolonged operating time. The commonest infective organism was Klebsiella Pneumoniae in 37% of which 19% were ESBL producing and 3.8% were carbapenemase producing. E. coli was identified in 20% of isolates. The incidence of ESBL in both isolates was higher.Conclusions: Regular audit of SSIs is a very effective tool to analyse risk factors, identify causes and plan strategies to prevent infection.

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Pediatric surgical site infection (SSI) following ambulatory surgery: Incidence, risk factors and patient outcomes

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.279 ◽

2021 ◽

pp. 1-7

Author(s):

Michael L. Rinke ◽

David G. Bundy ◽

Moonseong Heo ◽

Lisa Saiman ◽

Barbara Rabin ◽

...

Keyword(s):

Risk Factors ◽

Ambulatory Surgery ◽

Operative Procedure ◽

Epidemiologic Study ◽

Surgical Site Infections ◽

Incidence Rates ◽

Medical Centers ◽

Incidence Risk ◽

Contaminated Wound ◽

Clean Contaminated

Abstract Background: Inpatient surgical site infections (SSIs) cause morbidity in children. The SSI rate among pediatric ambulatory surgery patients is less clear. To fill this gap, we conducted a multiple-institution, retrospective epidemiologic study to identify incidence, risk factors, and outcomes. Methods: We identified patients aged <22 years with ambulatory visits between October 2010 and September 2015 via electronic queries at 3 medical centers. We performed sample chart reviews to confirm ambulatory surgery and adjudicate SSIs. Weighted Poisson incidence rates were calculated. Separately, we used case–control methodology using multivariate backward logistical regression to assess risk-factor association with SSI. Results: In total, 65,056 patients were identified by queries, and we performed complete chart reviews for 13,795 patients; we identified 45 SSIs following ambulatory surgery. The weighted SSI incidence following pediatric ambulatory surgery was 2.00 SSI per 1,000 ambulatory surgeries (95% confidence interval [CI], 1.37–3.00). Integumentary surgeries had the highest weighted SSI incidence, 3.24 per 1,000 ambulatory surgeries (95% CI, 0.32–12). The following variables carried significantly increased odds of infection: clean contaminated or contaminated wound class compared to clean (odds ratio [OR], 9.8; 95% CI, 2.0–48), other insurance type compared to private (OR, 4.0; 95% CI, 1.6–9.8), and surgery on weekend day compared to weekday (OR, 30; 95% CI, 2.9–315). Of the 45 instances of SSI following pediatric ambulatory surgery, 40% of patients were admitted to the hospital and 36% required a new operative procedure or bedside incision and drainage. Conclusions: Our findings suggest that morbidity is associated with SSI following ambulatory surgery in children, and we also identified possible targets for intervention.

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Wound infection in surgery department in BSMMU: A study of 100 cases

Journal of the Bangladesh Society of Anaesthesiologists ◽

10.3329/jbsa.v24i2.19804 ◽

2014 ◽

Vol 24 (2) ◽

pp. 65-69

Author(s):

M Nur-e-elahi ◽

I Jahan ◽

O Siddiqui ◽

SU Ahmed ◽

AI Joarder ◽

...

Keyword(s):

Risk Factors ◽

Wound Infection ◽

Elective Surgery ◽

Surgical Site Infections ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Surgical Patients ◽

Resistance Pattern ◽

Degree Of Contamination ◽

Surgery Department

Background Surgical site infections (SSI) are the most common nosocomial infection in surgical patients, accounting for 38% of all such infections, and are a significant source of postoperative morbidity resulting in increased hospital length of stay and increased cost. Objectives To find out the incidence of wound infection in patients following elective surgery and the most likely causative organisms and their resistance pattern. Methods Prospective data were collected on 496 surgical patients admitted in the surgery department in BSMMU from January 2010 to June 2010. All preoperative risk factors were evaluated. Patients operated were followed in the post operative period and if any wound infection noted, swab from the site of infection was sent for culture and sensitivity and antibiotics were given accordingly. Results Following 496 elective operations 20.16 % patients developed wound infection. Highest numbers of infection were seen in the fifth decade with slight female preponderance. Wound infection progressively rises with the degree of contamination and increasing operative time. The common risk factors for development of surgical wound infection were anemia (52%), malnutrition (44%), diabetes (38%), jaundice (30%), contaminated operation (44%) dirty operation (38 %), obesity and smoking. The most predominant isolated organism was Escherichia coli (43%) followed by Staphylococcus aureus (33%) and Pseudomonas aeruginosa (11%). Ceftriaxone still remains the most effective antibiotic although the incidence of resistance is rising. Conclusion Despite a good numbers of variables influence surgical site infections; it is still possible to reduce the infection rate by correcting modifiable risk factors, reducing degree of contamination and duration of operation. To battle the emerging resistance of pathogens a definitive guideline is essential. DOI: http://dx.doi.org/10.3329/jbsa.v24i2.19804 Journal of Bangladesh Society of Anaesthesiologists 2011; 24(2): 65-69

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Caesarean section wound infections and antibiotic use: a retrospective case-series in a tertiary referral hospital in The Gambia

Tropical Doctor ◽

10.1177/0049475517739539 ◽

2017 ◽

Vol 48 (3) ◽

pp. 192-199 ◽

Cited By ~ 6

Author(s):

Alex Aulakh ◽

Patrick Idoko ◽

Suzanne T Anderson ◽

Wendy Graham

Keyword(s):

Risk Factors ◽

Caesarean Section ◽

Antibiotic Prophylaxis ◽

Wound Infection ◽

Infection Rate ◽

Wound Infection Rate ◽

The Gambia ◽

Referral Hospital ◽

Wound Infections ◽

Preoperative Antibiotic Prophylaxis

Ours is the first published study to examine post-Caesarean section (CS) wound infections in The Gambia. We explored risk factors and clinical management retrospectively at a large referral hospital over a 12-month period. A total of 777 cases were identified and records for 682 (88%) were retrieved. The CS rate was 21.8% and the wound infection rate 13.2%. Risk factors included: length of labour; decision-to-incision time and stillbirth. Only 7.4% of women received preoperative antibiotic prophylaxis, but all women received multiple-dose, postoperative antibiotics. The wound infection rate found is likely to be an underestimate owing to loss to follow-up. The adherence to international guidelines regarding preoperative antibiotic prophylaxis needs to be improved.

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