BACKGROUND CONTEXT

In severe cases of postoperative spinal implant infections (PSII) multiple revision surgeries may be needed. Little is known if changes in the microbiological spectrum and antibiotic resistance pattern occur between revision surgeries.

PURPOSE

Analysis of the microbiological spectrum and antibiotic resistance pattern in patients with multiple revision surgeries for the treatment of PSII

STUDY DESIGN

Retrospective database analysis.

PATIENT SAMPLE

Between 01/2011 and 12/2018, 103 patients underwent 248 revision surgeries for the treatment of PSII. Twenty patients (19.4%) who underwent multiple revision surgeries for PSII were included in this study.

OUTCOME MEASURES

Microbiological spectrum, antibiotic resistance pattern.

METHODS

A retrospective analysis of a prospectively maintained single center spine infection database was performed with a minimum follow-up of 3 years. Overall, 20 patients (six male/14 female) underwent 82 revisions for PSII (median 3; range 2–12). There were 55 of 82 (67.1%) procedures with a positive microbiological result. Microbiological analysis was performed on tissue and implant sonication fluid. Changes in microbial spectrum and antibiotic resistance pattern between surgeries were evaluated using Chi-Square and Fisher's exact test.

RESULTS

In total, 74 microorganisms (83.3% gram-positive; 10.8% gram-negative) were identified. The most common microorganisms were Staphylococcus epidermidis (18.9%) and Cutibacterium acnes (18.9%). All S. epidermidis identified were methicillin-resistant (MRSE). Overall, there were 15 of 55 (27.3%) polymicrobial infections. The microbiological spectrum changed in 57.1% (20/35) between the revision stages over the entire PSII period. In 42.9% (15/35) the microorganism persisted between the revision surgeries stages. Overall, changes of the antibiotic resistance pattern were seen in 17.4% (8/46) of the detected microorganisms, comparing index revision and all subsequent re-revisions. Moreover, higher resistance rates were found for moxifloxacin and for ciprofloxacin at first re-revision surgery compared with index PSII revision. Resistances against vancomycin increased from 4.5% (1/23) at index PSII revision to 7.7% (2/26) at first re-revision surgery.

CONCLUSIONS

Changes of the microbiological spectrum and the resistance pattern can occur in patients with severe PSII who require multiple revision surgeries. It is important to consider these findings in the antimicrobial treatment of PSII. The microbiological analysis of intraoperative tissue samples should be performed at every revision procedure for PSII.

中文翻译：

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多次培养阳性翻修手术后脊柱植入物感染微生物谱和抗生素耐药模式的变化

背景语境

在严重的术后脊柱植入物感染 (PSII) 病例中，可能需要进行多次翻修手术。鲜为人知的是，在两次翻修手术之间是否会发生微生物谱和抗生素耐药模式的变化。

目的

多次翻修手术治疗 PSII 患者的微生物谱和抗生素耐药模式分析

学习规划

回顾性数据库分析。

患者样本

在 01/2011 和 12/2018 之间，103 名患者接受了 248 次修复手术以治疗 PSII。本研究纳入了 20 名因 PSII 接受过多次翻修手术的患者 (19.4%)。

结果测量

微生物谱，抗生素耐药模式。

方法

对一个前瞻性维护的单中心脊柱感染数据库进行了回顾性分析，并进行了至少 3 年的随访。总体而言，20 名患者（6 名男性/14 名女性）接受了 82 次 PSII 修正（中位数 3；范围 2-12）。82 次手术中有 55 次 (67.1%) 的微生物学结果呈阳性。对组织和植入物超声处理液进行了微生物学分析。使用卡方和 Fisher 精确检验评估手术之间微生物谱和抗生素耐药模式的变化。

结果

总共鉴定出 74 种微生物（83.3% 革兰氏阳性；10.8% 革兰氏阴性）。最常见的微生物是表皮葡萄球菌(18.9%) 和痤疮杆菌(18.9%)。鉴定出的所有表皮葡萄球菌均耐甲氧西林 (MRSE)。总体而言，55 例中有 15 例 (27.3%) 是多种微生物感染。在整个 PSII 期间，微生物谱在修订阶段之间发生了 57.1% (20/35) 的变化。在 42.9% (15/35) 中，微生物在修复手术阶段之间持续存在。总体而言，在 17.4% (8/46) 的检测到的微生物中观察到抗生素耐药性模式的变化，比较指数修订和所有后续的重新修订。此外，发现莫西沙星和与指数 PSII 翻修相比，第一次再翻修手术中使用环丙沙星。对万古霉素的耐药性从指数 PSII 翻修时的 4.5% (1/23) 增加到第一次翻修手术时的 7.7% (2/26)。

结论

需要多次翻修手术的严重 PSII 患者可能会发生微生物谱和耐药模式的变化。在 PSII 的抗菌治疗中考虑这些发现很重要。术中组织样本的微生物学分析应在 PSII 的每次翻修过程中进行。