Spinal hardware infection: Difference between revisions
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== Background == |
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* Also known as postoperative spinal implant infection |
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== Classification == |
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{| class="wikitable" |
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!Classification |
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!Acute Infection |
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!Chronic Infection |
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|- |
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|Pathogenesis: post-interventional |
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|<6 weeks post-interventionally (early onset) |
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|≥6 weeks post-interventionally (late onset) |
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|Pathogenesis: hematogenous or per continuitatem |
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|<6 weeks of symptoms |
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|≥6 weeks of symptoms |
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|- |
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|Clinical presentation |
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|acute pain, fever, prolonged wound secretion (>7-10 days), acute neurological deficits |
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|chronic pain, implant migration or loosening, fistula, neurological deficits |
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|- |
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|Typical pathogens |
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|[[Staphylococcus aureus]], [[Streptococcus]], [[Gram-negative bacteria]] |
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|[[coagulase-negative staphylococci]], [[Cutibacterium acnes]] |
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|} |
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== Management == |
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* Empiric therapy should be with [[vancomycin]] plus [[ceftriaxone]] or [[vancomycin]] plus [[piperacillin-tazobactam]] |
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* Antimicrobial management depends on the surgical approach: |
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** For removal of all hardware, treat with 6 weeks total (at least 2 weeks IV) |
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** For retainment with plan for eradication, treat with 12 weeks total (at least 2 weeks IV) |
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** For single-stage replacement, treat with 12 weeks total (at least 2 weeks IV) |
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** For retainment with plan for eventual removal, treat with at least 2 weeks IV followed by oral suppression until hardware removal |
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* Chronic suppressive antibiotics should be considered with difficult-to-treat organisms ([[Staphylococcus aureus]], resistant [[Gram-negative bacteria]], and fungal infections) |
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*Antibiotic treatment of postoperative spinal implant infections. ''J Spine Surg''. 2020;6(4):785–792. doi: [https://doi.org/10.21037/jss-20-456 10.21037/jss-20-456] |
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[[Category:Trauma and surgical patients]] |
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Latest revision as of 12:31, 22 August 2022
Background
- Also known as postoperative spinal implant infection
Classification
| Classification | Acute Infection | Chronic Infection |
|---|---|---|
| Pathogenesis: post-interventional | <6 weeks post-interventionally (early onset) | ≥6 weeks post-interventionally (late onset) |
| Pathogenesis: hematogenous or per continuitatem | <6 weeks of symptoms | ≥6 weeks of symptoms |
| Clinical presentation | acute pain, fever, prolonged wound secretion (>7-10 days), acute neurological deficits | chronic pain, implant migration or loosening, fistula, neurological deficits |
| Typical pathogens | Staphylococcus aureus, Streptococcus, Gram-negative bacteria | coagulase-negative staphylococci, Cutibacterium acnes |
Management
- Empiric therapy should be with vancomycin plus ceftriaxone or vancomycin plus piperacillin-tazobactam
- Antimicrobial management depends on the surgical approach:
- For removal of all hardware, treat with 6 weeks total (at least 2 weeks IV)
- For retainment with plan for eradication, treat with 12 weeks total (at least 2 weeks IV)
- For single-stage replacement, treat with 12 weeks total (at least 2 weeks IV)
- For retainment with plan for eventual removal, treat with at least 2 weeks IV followed by oral suppression until hardware removal
- Chronic suppressive antibiotics should be considered with difficult-to-treat organisms (Staphylococcus aureus, resistant Gram-negative bacteria, and fungal infections)
Further Reading
- Infection with spinal instrumentation: Review of pathogenesis, diagnosis, prevention, and management. Surg Neurol Int. 2013;4(Suppl 5):S392-403. doi: 10.4103/2152-7806.120783
- Antibiotic treatment of postoperative spinal implant infections. J Spine Surg. 2020;6(4):785–792. doi: 10.21037/jss-20-456
