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Female gender was protective against positive cultures in revision spine surgery
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CHICAGO — Among 51 patients with pseudarthrosis who underwent revision lumbar spine surgery and had intraoperative cultures, investigators found female gender was the only factor that was protective against a positive intraoperative culture, a finding that was consistent with the literature, according to a presenter at the North American Spine Society Annual Meeting.
In their single-center retrospective cohort study, Daniel A. Beckerman, MS, and his colleagues found 33% of patients undergoing revision lumbar surgery had at least one positive intraoperative culture and 13.7% of patients had more than two positive cultures.
“Consistent with the literature, we found female gender was protective against positive intraoperative cultures. We did not find any other statistically significant predictors of risk,” Beckerman said. “However, we did find the elevated odds ratios in patients who had instrumentation failure, as well as patients who had major risk factors for overt infection, as defined in the literature.”
At least one positive intraoperative culture was found in 17 patients and seven patients had two or more positive intraoperative cultures.
“Of the strains that we detected, it was commonly [Propionibacterium acnes] P. Acnes and [Staphylococcus epidermis] staph epidermis, but there were some other important nosocomial infections that were present,” Beckerman said.
Instrumentation failure was noted in 14 patients and was a major risk factor for infection among the study cohort, the results showed.
“Instrumentation or hardware loosening should raise the suspicion for subclinical infection. Based on the sheer prevalence alone of positive cultures obtained, it may be appropriate to obtain intraoperative cultures in all patients who undergo revision for lumbar pseudarthrosis and/or instrumentation failure without evidence or signs of overt clinical infection,” Beckerman said. – by Susan M. Rapp
Reference:
Beckerman DA, et al. Abstract 22. Presented at: North American Spine Society Annual Meeting; Sept. 25-28, 2019; Chicago.
Disclosure: Beckerman reports no relevant financial disclosures.
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Joseph H. Schwab, MD, MS
The study by Beckerman and colleagues retrospectively reviewed a consecutive series of 51 patients undergoing fusion of the thoracolumbar spine. Intraoperative tissue cultures were obtained in all cases and positive cultures were found in 33% (n= 17). Two or more positive cultures were found in 13.7% (n=7). Positive tissue cultures increased the odds of instrumentation failure.
Subclinical infection particularly with P. Acnes has been associated with implant loosening in arthroplasty. However, the association between these anaerobic bacterial infections and implant loosening is controversial with some studies reporting that the finding is merely a contaminant and that there is no causation between the bacteria and implant loosening. In spine, the association between P. acnes and back pain has been reported in several studies which were then followed by other studies that suggested that the findings were, again, due to a contaminant. The Beckerman paper will further stimulate discussion about how best to screen our patients for these subclinical indolent infections.
Massachusetts General Hospital
Harvard Medical School
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