Acute spinal implant infection treated with debridement: does extended antibiotic treatment improve the prognosis?
Pau Bosch-Nicolau1, Dolors Rodríguez-Pardo2,3, Carles Pigrau1,4
1Infectious Diseases Department, University Hospital Vall d'Hebron, Universitat Autónoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
Abstract:
The study aims to determine whether 8 weeks of antibiotics is non-inferior to 12 weeks in patients with acute deep spinal implant infection (SII). In the retrospective study of all SII cases (2009-2016), patients aged ≥ 15 years with microbiologically confirmed SII treated with debridement and implant retention were included. Whenever possible, tailored antibiotic treatment was used: rifampin/linezolid in gram-positive and quinolones in gram-negative infection. Patients were divided into short treatment course (8 weeks, ST group) and extended treatment (12 weeks, ET group). Primary outcome measure was percentage of cures at 1-year follow-up. One-hundred-twenty-four patients considered, 48 excluded based on the above criteria, leaving 76 patients, 28 ST and 48 ET. There were no differences in patient age, comorbidities, underlying pathologies, infection location, or surgery characteristics between groups. Surgery-to-debridement time was similar (18.5-day ST vs. 19-day ET; P = 0.96). Sixteen SII cases (21.1%) occurred with bloodstream infection. Pathogens found were Enterobacteriaceae (35, 46.1%), Staphylococcus aureus (29, 38.2%), coagulase-negative staphylococci (12, 15.8%), Pseudomonas aeruginosa (12, 15.8%), and Enterococcus faecalis (7, 9.2%). Twenty seven (35.5%) had polymicrobial infection. E. faecalis was more frequent in the ST group (7, 25% vs. 0; P < 0.001), and P. aeruginosa in ET (1, 3.6% vs. 11, 22.9%; P = 0.05). Five patients died of causes unrelated to SII. At 1-year follow-up, cure rates (21/26 ST, 80.8% vs. 39/45 ET, 86.7%; P = 0.52) and recurrences (2/26, 7.7% vs. 2/45, 4.4%; P = 0.62) were similar. Eight-week antimicrobial courses were not inferior to 12 weeks in patients with acute deep SII treated with prompt debridement, proper wound healing, and optimized antibiotics.
Insights
Eight weeks of antibiotics is as effective as 12 weeks for treating acute deep spinal implant infections (SII) when combined with prompt debridement and tailored antibiotic therapy. This finding supports shorter, effective antimicrobial courses for SII patients.
Area of Science:
- Infectious Diseases
- Orthopedic Surgery
- Pharmacology
Background:
- Acute deep spinal implant infection (SII) is a serious complication requiring effective antimicrobial treatment.
- The optimal duration of antibiotic therapy for SII, particularly after debridement and implant retention, remains an area of investigation.
- Current treatment paradigms often involve extended antibiotic courses, potentially leading to increased side effects and costs.
Purpose of the Study:
- To determine if an 8-week antibiotic course is non-inferior to a 12-week course in patients with acute deep SII.
- To evaluate cure rates and recurrence of infection at 1-year follow-up.
- To assess the safety and efficacy of shorter versus extended antibiotic durations in this patient population.
Main Methods:
- Retrospective study of 76 patients (aged ≥15 years) with microbiologically confirmed SII treated with debridement and implant retention (2009-2016).
- Patients were divided into an 8-week short treatment (ST) group (n=28) and a 12-week extended treatment (ET) group (n=48).
- Tailored antibiotic regimens were used, focusing on gram-positive and gram-negative pathogens, with cure rates assessed at 1-year follow-up.
Main Results:
- Cure rates at 1-year follow-up were similar between the ST and ET groups (80.8% vs. 86.7%, P=0.52).
- Recurrence rates were also comparable (7.7% vs. 4.4%, P=0.62).
- No significant differences were observed in patient demographics, comorbidities, infection characteristics, or surgery details between the groups.
Conclusions:
- An 8-week course of antibiotics is non-inferior to a 12-week course for treating acute deep spinal implant infections when combined with prompt debridement and implant retention.
- Optimized, tailored antibiotic selection and proper wound management are crucial for successful outcomes.
- Shorter antibiotic durations may be a viable option, potentially reducing treatment burden without compromising efficacy.
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