Treatment of methicillin-resistant Staphylococcus aureus (MRSA) infection after spine surgery: 8 cases report

English Keywords:Spine surgery  Surgical site infection  Methicillin-resistant Staphylococcus aureus  Irrigation and drainage  Implants

English Abstract:

  【Abstract】 Objectives: To investigate the treatment for methicillin-resistant Staphylococcus aureus(MRSA) infection after spine surgery. Methods: From July 2007 to December 2012, a total of 8 MRSA infected cases(6 females and 2 males) following spine surgery and with an average age at admission of 54.3 years(range, 32-72 years) was reviewed retrospectively, and their therapeutic results were observed retrospectively. All 8 cases underwent debridement, irrigation and drainage(I & D). The irrigation volume and time to remove the irrigating/drainage tube depended on the result of cultruing results of drainage. All cases took antibiotics as adjutant therapy, wound secretion was collected for bacterial culturing and drug sensitive test before the use of broad-spectrum antibiotics, and antibiotics would be adjusted according to the result of drug sensitivity test. In some cases, oral antibiotics were used together. Results: One MRSA infection case was dead and 7 cases had wound healed, the 7 cases were followed up for 5-43 months(average, 21 months), no recurrence of infection was found at last follow-up. Among the 7 cases, 4 cases had the implants maintained, while removed in the other 3 cases. The average duration of hospitalization was 91.8 days (range, 26-200 days), 5 cases readmitted after the primary operation, maximized to 5 times. The average duration of intravenous antibiotics treatment was 55.5 days(range, 14-144 days), 5 cases took oral antibiotics together, which lasted for 31.4 days(range, 11-73 days). Four of those 8 cases required multiple debridement with the maximum of 5 times, one case eventually turned to undergo musculocutaneous flap transplantation to cover the complex wound. Conclusions: Due to MRSA′s resistance to many antibiotics after postoperative spinal infection, prolonged hospitalization and use of amount of antibiotics, multiple debribements, even removement of implants, can be considered. Implants removal should be taken into consideration when: (1)MRSA infection over more than 30 days after primary operation; (2)MRSA infection is still uncontrolled even after more than 3 times of debridement.