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In Vivo Mouse Model of Spinal Implant Infection
Published on: June 23, 2020
Three-month antibiotic therapy for early-onset postoperative spinal implant infections
Vincent Dubée1, Thibaut Lenoir, Véronique Leflon-Guibout
1Service de Médecine Interne, Hôpital Beaujon, 100 boulevard du général Leclerc, 92110 Clichy, France.
Background:
Optimal duration and modalities of antibiotic therapy for early-onset spinal implant infection (EOSII) remain controversial.
Methods:
Between November 2004 and November 2007, we conducted a prospective, monocentric study to assess the efficacy of a 3-month course of antibiotics for patients diagnosed with EOSII, as defined by a proven deep infection of the surgical site occurring within 30 days after spinal instrumented surgery. All patients with EOSII underwent surgical debridement with implant retention. Combination antibiotic therapy was administered intravenously for 2 weeks. Treatment was switched orally for the following 10 weeks.
Results:
50 patients matched the inclusion criteria and were included in this study. The median age was 68 (interquartile range [IQR]: 51-75) years; the median ASA score was 2 (IQR: 2-2). Emergency spinal surgery had been performed in 18 patients. Staphylococcus aureus was the most frequently isolated pathogen (n=27), followed by Enterobacteriaceae (n=22) and coagulase-negative staphylococci (n=6). Seventeen patients had polymicrobial infections, and 13 patients (26%) had bacteremia. The median time from the first symptoms of infection to debridement surgery was 3 days (IQR: 2-5 days). Three patients underwent 2 debridement surgeries. The median follow-up was 43 (IQR: 34-54) months. The 2-year survival rate for those who did not experience treatment failure was 88% (95% confidence interval [CI]: 75.7%-95.5%). Three patients experienced treatment failure (6%, 95% CI: 1.3%-16.5%), including 1 relapse due to methicillin-susceptible S. aureus and 2 reinfections with another pathogen.
Conclusions:
In this homogenous cohort of 50 patients with EOSII, treatment consisting of debridement surgery with implant retention followed by combination antibiotic therapy for 3 months appeared safe and effective.
Insights
A 3-month antibiotic course combined with surgical debridement and implant retention is safe and effective for early-onset spinal implant infections (EOSII). This treatment approach demonstrated an 88% 2-year survival rate in a study of 50 patients.
Area of Science:
- Orthopedics
- Infectious Diseases
- Surgical Oncology
Background:
- Optimal antibiotic duration for early-onset spinal implant infections (EOSII) is debated.
- EOSII requires timely and effective treatment strategies.
Purpose of the Study:
- To assess the efficacy and safety of a 3-month antibiotic regimen for EOSII.
- To evaluate treatment outcomes in patients undergoing debridement with implant retention.
Main Methods:
- Prospective monocentric study of 50 patients with EOSII (within 30 days post-surgery).
- Surgical debridement with implant retention followed by 2 weeks IV and 10 weeks oral combination antibiotics.
- Median follow-up of 43 months.
Main Results:
- Staphylococcus aureus was the most common pathogen.
- 26% of patients had bacteremia; 6% experienced treatment failure (relapse/reinfection).
- 88% 2-year survival rate observed in patients without treatment failure.
Conclusions:
- A 3-month antibiotic course with debridement and implant retention is safe and effective for EOSII.
- This treatment strategy shows promising outcomes in a homogenous patient cohort.
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