MANAGEMENT OF POSTOPERATIVE INFECTIONS AFTER SPINAL INSTRUMENTATION

The authors retrospectively reviewed 452 consecutively treated patient s who underwent a spinal instrumentation procedure at a single institu tion to establish which patients and which surgical approaches might b e associated with an increased risk of developing deep wound infection s and to determine the efficacy with which the institution's current t reatment strategy eradicates these infections. Wound infections occurr ed in 17 patients (10 men and seven women) with spinal instrumentation (incidence 3.8%). All infections occurred after posterior spinal inst rumentation procedures (7.2%); there were no infections after anterior instrumentation procedures regardless of the level. Each patient was assigned an infection risk factor (RF) score depending on the number o f RFs identified in an individual patient preoperatively. The mean RF score of patients who developed infections was 2.18, whereas the mean RF score for a procedure-matched , infection-free control group was 0. 71. The mean number of days from surgery to clinical presentation was 27.6 days (range 4-120 days), and the mean increase in hospitalization time for the subset of patients who developed infections was 16.6 day s. The most common organism isolated from wound cultures was Staphyloc occus aureus (nine of 17 cases). Of the 17 patients, five had infectio ns involving multiple organisms. All patients were infection free at a minimum of 8 months follow-up review. The current treatment regimen a dvocated at this institution consists of operative debridement of the infected wound, a course of intravenous followed by oral antibiotic me dications, insertion of an antibiotic-containing irrigation-suction sy stem for a mean of 5 days, and maintenance of the instrumentation syst em within the infected wound.