Antibiotic treatment of postoperative spinal implant infections

Area of Science:

• Spinal surgery
• Infectious diseases
• Pharmacology

Background:

• Postoperative spinal implant infection (PSII) is a significant complication of spinal surgery.
• PSII presents diagnostic and therapeutic challenges due to biofilm formation on implants.
• It leads to increased patient morbidity, mortality, and healthcare costs.

Purpose of the Study:

• To review current antibiotic treatment strategies for PSII.
• To provide guidance on antibiotic choice, combination, and duration.
• To discuss empiric and pathogen-specific antibiotic approaches.

Main Methods:

• Review of current literature on PSII antibiotic treatment.
• Analysis of recommended antibiotic durations and combinations for implant removal versus retention.
• Identification of common pathogens and necessary empiric coverage.

Main Results:

• For late-onset PSII with implant removal, 2 weeks IV followed by 4 weeks oral antibiotics are suggested.
• If implants are retained, 2 weeks IV followed by 10 weeks oral antibiotics with biofilm activity are recommended.
• Long-term suppression therapy may be needed for problematic pathogens.
• Empiric therapy should cover common pathogens like staphylococci, streptococci, enterococci, and Gram-negative bacilli.

Conclusions:

• Effective PSII treatment relies on appropriate antibiotic selection, combination, and duration.
• Tailoring antibiotic therapy based on pathogen susceptibility is crucial for successful eradication.
• Modern protocols enable efficient PSII management and good clinical outcomes.