Article Abstract

Variables associated with remission in spinal surgical site infections

Authors: Julien Billières, Ilker Uçkay, Antonio Faundez, Jonathan Douissard, Paulina Kuczma, Domizio Suvà, Mathieu Zingg, Pierre Hoffmeyer, Dennis E. Dominguez, Guillaume Racloz


Background: There is few medical literature regarding factors associated with remission after surgical and medical treatment of postoperative spine infections.
Methods: Single-centre case-control study 2007–2014. Cluster-controlled Cox regression model with emphasis on surgical and antibiotic-related parameters.
Results: Overall, we found 66 episodes in 48 patients (49 episodes with metalwork) who had a median follow-up of 2.6 years (range, 0.5 to 6.8 years). The patients had a median of two surgical debridements. The median duration of antibiotic therapy was 8 weeks, of which 2 weeks parenteral. Clinical recurrence after treatment was noted in 13 episodes (20%), after a median interval of 2 months. In 53 cases (80%), the episodes were considered as in remission. By multivariate analyses, no variable was associated with remission. Especially, the following factors were not significantly related to remission: number of surgical interventions [hazard ratio (HR) 0.9; 95% confidence interval (CI), 0.8–1.1]; infection due to Staphylococcus aureus (HR 0.9; 0.8–1.1), local antibiotic therapy (HR 1.2; 0.6–2.4), and, duration of total (HR 1.0; 0.99–1.01) (or just parenteral) (HR 1.0; 0.99–1.01) antibiotic use.
Conclusions: In patients with post-operative spine infections, remission is achieved in 80%. The number of surgical debridement or duration of antibiotic therapy shows no association with recurrence, suggesting that individual risk factors might be more important than the duration of antibiotic administration.