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Surgical irrigation with pooled human immunoglobulin G to reduce post-operative spinal implant infection
K A Poelstra1, N A Barekzi, J B Slunt
1Anthony G. Gristina Institute for Biomedical Research, Herndon, Virginia, USA. kap7c@virginia.edu
Abstract:
A multiple-site, nonlethal rabbit surgical model of spinal implant infection was used to assess the efficacy of a spinal wound lavage to reduce post-operative infection from methicillinresistant Staphylococcus aureus (MRSA). Multiple aqueous lavages of isotonic saline were compared to the same procedure using 1wt% pooled human immunoglobulin G (IgG) applied directly to the surgical implant sites. Visually observed clinically relevant signs of infection (e.g. , swelling, erythema, pus) were supported by bacterial enumeration from multiple biopsied tissue and bone sites post-mortem at 7 and 28 days post-challenge. Clinical signs of infection were significantly reduced in IgG-lavaged infected spinal sites. Bacterial enumeration also exhibited statistically significant reductions in soft tissues, bone and on K-wire spinal implants using IgG lavage compared with saline. Complete healing of all surgical wounds was seen after 28 days, although isolated fibrosed abscesses were observed in autopsied sites treated with both IgG and saline lavages. Local use of IgG wound lavage is proposed as supplementary infection prophylaxis against antibiotic resistant implant-centered or surgical wound infection.
Insights
Human immunoglobulin G (IgG) spinal wound lavage significantly reduced infection signs and bacterial load in a rabbit model of methicillin-resistant Staphylococcus aureus (MRSA) spinal implant infection, offering potential for antibiotic-resistant infection prophylaxis.
Area of Science:
- Orthopedics
- Infectious Diseases
- Surgical Innovation
Background:
- Spinal implant infections pose significant challenges, particularly those caused by antibiotic-resistant bacteria like methicillin-resistant Staphylococcus aureus (MRSA).
- Effective prophylaxis strategies are crucial to mitigate post-operative complications and improve patient outcomes in spinal surgery.
Purpose of the Study:
- To evaluate the efficacy of human immunoglobulin G (IgG) spinal wound lavage in reducing post-operative MRSA infection in a rabbit surgical model.
- To compare the effectiveness of IgG lavage against standard isotonic saline lavage in controlling bacterial load and clinical signs of infection.
Main Methods:
- A nonlethal, multiple-site rabbit surgical model was established to induce MRSA spinal implant infections.
- Surgical implant sites were lavaged with either isotonic saline or 1% pooled human IgG.
- Clinical signs of infection, bacterial enumeration in tissues and on implants, and wound healing were assessed at 7 and 28 days post-infection.
Main Results:
- IgG lavage significantly reduced visible clinical signs of infection, such as swelling, erythema, and pus, compared to saline lavage.
- Bacterial counts in soft tissues, bone, and on spinal implants were statistically lower in the IgG lavage group.
- Complete wound healing was observed by 28 days, though fibrosed abscesses occurred in both treatment groups.
Conclusions:
- Local application of human IgG wound lavage demonstrates significant potential as an adjunctive prophylactic measure against antibiotic-resistant spinal implant and surgical wound infections.
- IgG lavage offers a promising supplementary strategy to combat challenging MRSA infections in orthopedic surgery.