Single debridement, hardware retention, IV antibiotics work for deep surgical site infections
TUESDAY, June 22 (HealthDay News) -- Both deep and superficial surgical site infections (SSIs) after spinal surgery are usually caused by Staphylococcus aureus; successful treatment of deep infections is possible with single stage debridement and intravenous antibiotics, and superficial infections can effectively be treated with local wound care and oral antibiotic therapy, according to research published in the June 1 issue of Spine.
Albert F. Pull ter Gunne, M.D., of the Johns Hopkins Hospital in Baltimore, and colleagues conducted a descriptive, retrospective cohort analysis of spinal surgery patients at a single hospital who developed SSIs after spinal surgery.
The researchers found that either deep or superficial SSIs were detected in 132 of 3,174 spinal surgery patients, with the average time of presentation at 28.7 days postoperatively. Presentation was typically with wound drainage (68.2 percent) and an elevated C-reactive protein (98 percent) or erythrocyte sedimentation rate (94.4 percent); less than half (48.6 percent) had an elevated white blood cell count on presentation. S. aureus was the most frequently identified pathogen in both superficial and deep SSIs (85.7 and 72.6 percent, respectively). Deep SSIs were effectively treated with a single debridement (76 percent of the time) plus intravenous antibiotics; hardware was retained in most cases. Most superficial SSIs were effectively treated with local wound care and oral antibiotics (72.9 percent).
"In our cohort, the routine treatment for deep infections included aggressive debridement of the wound and soft tissues, retention of all stable hardware, and primary replacement of instrumentation if fixation failure had occurred. Primary wound closure over multiple drains was performed. With this method 76.0 percent of deep SSI could be treated with a single surgical debridement. Further debridements were performed if clinical evidence of uncontrolled infection continued," the authors write.
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