Is aggressive surgery necessary for acute postoperative deep spinal wound infection?

A retrospective study of the clinical results of conservative treatment of patients with acute postoperative deep spinal infection.

To determine the efficacy of antibiotic only treatment of postoperative deep spinal infection.

Traditionally, aggressive surgical treatment combined with antibiotics has been viewed as the gold standard for treating postoperative deep spinal infection. There are, however, disadvantages to surgical treatment including higher treatment cost, multiple anesthesia and surgeries, and the risk of perioperative morbidity and mortality particularly in immunocompromised patients. Although many new antibiotics and new methods of antibiotic treatment have recently become available, the role of conservative treatment using antibiotics alone to treat postoperative acute infection has not yet been determined.

Ten consecutive patients with acute postoperative spinal infection were treated using antibiotics alone. The mean onset of the symptoms of infection after surgery was 15.4 days (range, 5-18 days). Seven patients had purulent wound drainage; 3 had healed wounds without discharge. Bacterial culture of the discharge showed methicillin-resistant Staphylococcus aureus (1 patient), methicillin-resistant coagulase negative Staphylococcus (4 patients), methicillin-sensitive coagulase negative Staphylococcus (1 patient). One patient had a negative culture. Patients with wound drainage were treated with intravenous vancomycin or teicoplamin for 4 to 6 weeks followed by oral antibiotics (quinolone with/without rifampin) for 1 to 3 months. All other patients were treated with oral antibiotics for 3 months.

One patient could not complete treatment because of allergy to antibiotics. Infection was controlled in the remaining patients without surgical intervention and did not reoccur. All wound drainage ceased within 2 weeks. The C-reactive protein level of most patients returned to normal range within 10 weeks.

Antibiotic treatment alone may be effective in the treatment of acute postoperative spinal infection when diagnosis is prompt. Aggressive surgery may be not necessary and may be reserved for patients who fail conservative treatment.