Therapeutic outcome of spinal implant infections caused by Staphylococcus aureus A retrospective observational studyopen access
- Cho, Oh-Hyun; Bae, In-Gyu; Moon, Song Mi; Park, Seong Yeon; Kwak, Yee Gyung; Kim, Baek-Nam; Yu, Shi Nae; Jeon, Min Hyok; Kim, Tark; Choo, Eun Ju; Lee, Eun Jung; Kim, Tae Hyong; Choi, Seong-Ho; Chung, Jin-Won; Kang, Kyung-Chung; Lee, Jung Hee; Lee, Yu-Mi; Lee, Mi Suk; Park, Ki-Ho
- Issue Date
- LIPPINCOTT WILLIAMS & WILKINS
- instrumentation; outcome; rifampin; spondylitis; treatment; vertebral osteomyelitis
- MEDICINE, v.97, no.40
- Journal Title
- Spinal implant infection is a rare but significant complication of spinal fusion surgery, and the most common pathogen is Staphylococcus aureus. It is difficult to treat due to this pathogen's biofilm-forming ability and antibiotic resistance. We evaluated the therapeutic outcome of treatments for S aureus spinal implant infections. We retrospectively reviewed all patients with S aureus spinal implant infections at 11 tertiary-care hospitals over a 9-year period. Parameters predictive of treatment failure and recurrence were analyzed by Cox regression. Of the 102 patients with infections, 76 (75%) were caused by methicillin-resistant S aureus (MRSA) and 51 (50%) were late-onset infections. In all, 83 (81%) patients were managed by debridement, antibiotics, and implant retention (DAIR) and 19 (19%) had their implants removed. The median duration of all antibiotic therapies was 52 days. During a median follow-up period of 32 months, treatment failure occurred in 37 (36%) cases. The median time to treatment failure was 113 days, being <1 year in 30 (81%) patients. DAIR (adjusted hazard ratio [aHR], 6.27; P=.01) and MRSA infection (aHR, 4.07; P=.009) were independently associated with treatment failure. Rifampin-based combination treatments exhibited independent protective effects on recurrence (aHR, 0.23; P=.02). In conclusion, among patients with S aureus spinal implant infections, MRSA and DAIR were independent risk factors for treatment failure, and these risk factors were present in the majority of patients. In this difficult-to-treat population, the overall treatment failure rate was 36%; rifampin may improve the outcomes of patients with S aureus spinal implant infections.
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- College of Medicine > Department of Medicine > Journal Articles
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