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Enterobacter Infection after Spine Surgery: An Institutional Experience
Jang W Yoon1, Nathan R Wanderman2, Panagiotis Kerezoudis3
1Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA.
World Neurosurgery
|December 1, 2018
Summary
Gram-negative surgical site infections (SSIs) caused by Enterobacter species are increasing after spine surgery. These infections require more interventions but can be successfully treated with timely debridements, preserving original implants.
Area of Science:
- Infectious Diseases
- Orthopedic Surgery
- Microbiology
Background:
- Gram-negative surgical site infections (SSIs) are a growing concern following spine surgery, often linked to extensive antibiotic use.
- Enterobacter species are frequently identified as the causative agents in these gram-negative SSIs.
Purpose of the Study:
- To investigate the characteristics and outcomes of Enterobacter-related SSIs after spine surgery.
- To compare Enterobacter SSIs with non-Enterobacter SSIs in the same patient population.
Main Methods:
- A retrospective review of a single institution's database from 2009-2016.
- Analysis of demographic, clinical, and operative data for patients with Enterobacter SSIs.
- Comparison of Enterobacter SSI cases against a cohort with non-Enterobacter SSIs.
Main Results:
- Enterobacter species were identified in 16 patients (14.5% of spinal SSIs), associated with higher BMI, earlier wound dehiscence, and polymicrobial infections.
- Patients with Enterobacter SSIs required significantly more multiple irrigations and debridements (I&Ds) (43.8% vs. 18.1%) and had a longer length of stay (18 vs. 5 days).
- Despite challenges, 15 surviving patients achieved infection-free status with retained implants after a mean follow-up of 24.2 months.
Conclusions:
- Enterobacter SSIs in spine surgery patients present with distinct risk factors including higher BMI and polymicrobial nature.
- Vigilant surveillance and prompt surgical interventions, including I&Ds, are crucial for successful management.
- Successful treatment outcomes, including implant retention, are achievable for Enterobacter SSIs with appropriate management.
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