Diagnosis and treatment of deep surgical site infection after lumbar surgery

English Keywords:Lumbar  Deep  Surgical site infection  Diagnosis  Treatment

English Abstract:

  【Abstract】 Objectives: To investigate the clinical characteristics and the treatment strategy of deep surgical site infection after lumbar operation. Methods: Fourteen cases of deep surgical site infection after lumbar surgery were analyzed retrospectively between January 2012 and July 2017. There were 9 males and 5 females with a mean age of 53.0±13.1 years. 3 cases were from our hospital, and 11 cases were transferred from other hospitals. There were 13 early infections and 1 delayed infection. There were 13 cases with internal fixation and 1 case without internal fixation in the primary surgeries. After the symptoms of infection occurred, specimens were taken for bacterial cultures and antibiotic susceptibility tests. Simultaneously, patients were empirically administered intravenously. Then, the antibiotics were adjusted according to the results of bacterial cultures and the changes of patients′ conditions. After the main inflammatory indicators were normal, intravenous antibiotics were replaced by oral antibiotics. 12 cases who did not improve their condition after antibiotic treatment were completely debrided under general anesthesia: 4 cases were treated by continuous irrigation and drainage after debridement; the other 8 cases received debridement and vacuum sealing drainage(VSD). Results: Total 7 patients were positive for bacterial culture, including 6 cases of single bacterial infection and 1 case of mixed infection. All patients were administered antibiotics with an average of 39.7±13.2d(24-77d) for intravenous antibiotics and 32.9±3.1d(28-38d) for oral antibiotics. Among the 13 patients with infection after internal fixation, the implants of 11 cases were retained and 2 cases were removed after multiple debridement. The average length of hospital stay was 51.4±13.1 days. All the deep infections were controlled and patients achieved an average of 32.4±18.6 months(4-67 months) followed-up. No recurrence of infection was found at final follow-up. Conclusions: Antibiotics and surgical debridement are effective treatments for deep surgical site infection after lumbar surgery. For patients with early infection, active treatments can prevent removal of implants.