Spinal hardware infection: Difference between revisions
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| + | == Background == |
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| − | = Spinal hardware infections = |
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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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| + | |- |
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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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== Further Reading == |
== Further Reading == |
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| − | * |
+ | * Infection with spinal instrumentation: Review of pathogenesis, diagnosis, prevention, and management. ''Surg Neurol Int''. 2013;4(Suppl 5):S392-403. doi: [https://doi.org/10.4103/2152-7806.120783 10.4103/2152-7806.120783] |
| + | *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 08:31, 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
