Vertebral osteomyelitis after spine instrumentation surgery: risk factors and management.
J Hosp Infect
; 140: 102-109, 2023 Oct.
Article
em En
| MEDLINE
| ID: mdl-37482096
ABSTRACT
BACKGROUND:
Vertebral osteomyelitis after spine instrumentation surgery (pVOM) is a rare complication. Most cases of infection occur early after surgery that involve skin and soft tissue and can be managed with debridement, antibiotics, and implant retention (DAIR).AIM:
To identify pVOM risk factors and evaluate management strategies.METHODS:
From a multicentre cohort of deep infection after spine instrumentation (IASI) cases (2010-2016), pVOM cases were compared with those without vertebral involvement. Early and late infections were defined (<60 days and >60 days after surgery, respectively). Multivariate analysis was used to explore risk factors.FINDINGS:
Among 410 IASI cases, 19 (4.6%) presented with pVOM, ranging from 2% (7/347) in early to 19.1% (12/63) in late IASIs. After multivariate analysis, age (adjusted odds ratio (aOR) 1.10; 95% confidence interval (CI) 1.03-1.18), interbody fusion (aOR 6.96; 95% CI 2-24.18) and coagulase-negative staphylococci (CoNS) infection (aOR 3.83; 95% CI 1.01-14.53) remained independent risk factors for pVOM. Cases with pVOM had worse prognoses than those without (failure rate; 26.3% vs 10.8%; P = 0.038). Material removal was the preferred strategy (57.9%), mainly in early cases, without better outcomes (failure rate; 33.3% vs 50% compared with DAIR). Late cases managed with removal had greater success compared with DAIR (failure rate; 0% vs 40%; P = 0.067).CONCLUSION:
Risk factors for pVOM are old age, use of interbody fusion devices and CoNS aetiology. Although the diagnosis leads to a worse prognosis, material withdrawn should be reserved for late cases or when spinal fusion is achieved.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Osteomielite
/
Infecções Relacionadas à Prótese
Tipo de estudo:
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Humans
Idioma:
En
Revista:
J Hosp Infect
Ano de publicação:
2023
Tipo de documento:
Article