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Infectious complications after traumatic spine injury requiring surgery in a French level-1 trauma center: An
Georgios Wallden1, Thomas Botrel2, Florian Blanchard3
1Department of Anesthesiology and Critical Care, AP-HP Pitié-Salpêtrière University Hospital, 43-87 Bd de l'Hôpital, 75013, Paris, France.
Background:
Traumatic spine injury (TSI) is a prevalent condition that often requires surgical intervention. Two serious infectious complications after surgery are surgical site infections (SSI) and lower respiratory tract infections (LRTI). Yet, studies on SSI and LRTI on trauma patients, particularly with a specific focus on microbiology are lacking. The primary aim of this study is to investigate the prevalence rate of early SSI, occurring within one month of surgery or three months when instrumented, and LRTI in level-1 trauma center patients requiring surgery after TSI.
Methods:
This monocenter retrospective observational study was conducted at an academic level-1 trauma center, including patients with TSI requiring surgery. Data on patients' baseline characteristics, trauma related information, initial and intra-operative management, infectious complications data and hospitalization outcomes were collected. The two primary outcomes were the prevalence of early SSI and LRTI. Secondary outcomes included the identification of factors associated with developing these infections, analysis of identified organisms, and assessment of clinical outcomes.
Results:
A total of 2606 patients were screened between May 2018 and October 2022, 194 were included. Most of them were polytrauma patients defined by Injury Severity Score ≥ 16 (71 %). Early SSI occurred in 20 patients (10 %) and LRTI occurred in 58 patients (30 %). The number of vertebral levels instrumented (odds ratio [OR] 1.24, 95 % confidence interval [95 % CI] 1.01-1.52) was associated with SSI. The causative organisms were predominantly Gram-positive cocci (19/36 identified organisms). Factors associated with LRTI were an injury severity score ≥ 25 (OR 7.41; 95 % CI, 3.28-17.99), spinal injury at levels C3-C7 (OR 2.24; 95 % CI 1.01-5.14) and antibiotics during initial management (OR 7.09; 95 % CI, 2.71-20.49). The causative organisms were predominantly Gram-negative bacilli (58/80 identified organisms). Patients with LRTI experienced longer hospital stays, extended durations of mechanical ventilation, and higher mortality rates at 30 days and one year than those without.
Conclusion:
Early SSI and LRTI are underestimated complications in severe trauma patients with TSI requiring surgery. Identifying risk factors and causative organisms is an important step for advancing research on targeted prevention and treatment of SSI and LRTI after trauma.
Insights
Surgical site infections (SSI) and lower respiratory tract infections (LRTI) are common after traumatic spine injury (TSI) surgery. This study highlights their prevalence and risk factors, emphasizing the need for targeted prevention strategies.
Area of Science:
- Trauma Surgery
- Infectious Diseases
- Spinal Surgery
Background:
- Traumatic spine injury (TSI) often necessitates surgical intervention, carrying risks of serious infectious complications like surgical site infections (SSI) and lower respiratory tract infections (LRTI).
- Limited research exists on the microbiology of SSI and LRTI in trauma patients undergoing spinal surgery.
- Understanding these infections is crucial for improving patient outcomes in trauma care.
Purpose of the Study:
- To investigate the prevalence of early SSI and LRTI in patients with TSI requiring surgery at a level-1 trauma center.
- To identify risk factors, causative organisms, and clinical outcomes associated with SSI and LRTI post-TSI surgery.
- To provide data for developing targeted prevention and treatment strategies for these infections.
Main Methods:
- A monocenter retrospective observational study included patients with TSI requiring surgery.
- Data collected encompassed baseline characteristics, trauma details, surgical management, and infectious complications.
- Primary outcomes were the prevalence of early SSI and LRTI; secondary outcomes included risk factor analysis and microbiological identification.
Main Results:
- Of 194 included patients, 10% developed early SSI and 30% developed LRTI.
- Increased vertebral levels instrumented correlated with SSI. Factors for LRTI included high injury severity, cervical spine injury, and pre-operative antibiotics.
- Gram-positive cocci were predominant in SSI, while Gram-negative bacilli were common in LRTI. LRTI patients faced longer hospital stays, ventilation, and higher mortality.
Conclusions:
- Early SSI and LRTI are significant, underestimated complications following TSI surgery.
- Identifying specific risk factors and microbial patterns is essential for targeted interventions.
- Further research into prevention and treatment is needed to mitigate the impact of these infections.
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