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Continuous local antibiotic perfusion for patients with surgical site infection after instrumented spinal surgery; a novel technique to retain the implants
Journal of Clinical Neuroscience ( IF 2 ) Pub Date : 2021-09-13 , DOI: 10.1016/j.jocn.2021.09.001
Hiroshi Takahashi 1 , Masao Koda 1 , Toru Funayama 1 , Hiroshi Noguchi 1 , Kousei Miura 1 , Kentaro Mataki 1 , Yosuke Shibao 1 , Fumihiko Eto 1 , Mamoru Kono 1 , Kosuke Sato 1 , Tomoyuki Asada 1 , Shun Okuwaki 1 , Tomoaki Shimizu 1 , Akira Ikumi 2 , Kengo Fujii 3 , Yasuhiro Shiga 4 , Kazuhide Inage 4 , Yawara Eguchi 4 , Sumihisa Orita 4 , Junya Saito 5 , Yasuchika Aoki 6 , Seiji Ohtori 4 , Masashi Yamazaki 1
Affiliation  

Objectives

To describe the novel technique of continuous local antibiotic perfusion (CLAP) for a surgical site infection (SSI) after instrumented spinal surgery.

Methods

CLAP was applied to 4 continuous patients at our institution who developed SSI after instrumented spinal surgery.

Results

All 4 patients were successfully treated and the infection was controlled. The implant was retained in all patients. The duration of CLAP ranged from 2 to 3 weeks. The blood level of the antibiotic used (gentamicin) at 1 week after the initiation of CLAP did not increase in any patient. No other adverse events occurred in any patient. Dramatic improvements in laboratory parameters, including the white blood cell (WBC) counts and C-reactive protein (CRP) levels were seen in every patient at 1 week after the initiation of CLAP.

Conclusions

CLAP controlled the infection without severe adverse events in all 4 patients, and the implants were retained. Despite its cost and the discomfort of patients, CLAP may become an option for the treatment of SSIs after instrumented spinal surgery. A large number of case series are needed to verify the efficacy of CLAP for patients with SSIs after instrumented spinal surgery.



中文翻译:

脊柱器械手术后手术部位感染患者持续局部抗生素灌注;一种保留植入物的新技术

目标

描述连续局部抗生素灌注 (CLAP) 治疗脊柱器械手术后手术部位感染 (SSI) 的新技术。

方法

CLAP 应用于我们机构的 4 名连续患者,这些患者在脊柱器械手术后发生了 SSI。

结果

4名患者均得到成功治疗,感染得到控制。所有患者均保留植入物。CLAP 的持续时间为 2 至 3 周。在开始 CLAP 后 1 周,所用抗生素(庆大霉素)的血液水平在任何患者中均未升高。任何患者均未发生其他不良事件。在开始 CLAP 后 1 周,每位患者的实验室参数,包括白细胞 (WBC) 计数和 C 反应蛋白 (CRP) 水平都有显着改善。

结论

CLAP 控制了所有 4 名患者的感染,没有出现严重的不良事件,并且保留了植入物。尽管成本高且患者感到不适,但 CLAP 可能成为脊柱器械手术后 SSI 治疗的一种选择。需要大量病例系列来验证 CLAP 对脊柱器械手术后 SSI 患者的疗效。

更新日期:2021-09-13
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