fellow complex spine university of south alabama MOBILE AL, AL, US
Introduction: Infections after spine surgery range from 0% to 18%. IV antibiotics may not achieve high local concentrations, but local antibiotic delivery methods, like CaSO4 beads, provide sustained antibiotic release. These beads maintain higher local antibiotic levels for weeks, exceeding pathogen MIC minimizing systemic toxicity, reducing infection risk.
Methods: Retrospectively evaluated 61 pts treated for spine deformity, trauma, infections, and degenerative disease from Mar2023 to Jan 2024. Demographics, surgical site, lab/microbiology investigations, antibiotics used, complications, and outcomes were recorded. Follow-up ranged from 1 to 11 months. Infection resolution assessed using clinical, MRI, and labs (ESR, CRP, WBC).
Results: 61 patients (37 females, 24 males; mean age 63.5±11.73 years). Hypertension (72.13%) and diabetes (18.03%) were common comorbidities, and 65.57% were smokers. Mean HBA1c was 5.88±1.09, albumin 3.65±0.78, pre-op calcium 9.06±0.68, post-op calcium 8.65±0.70, and creatinine remained stable pre- and post-op. Positive cultures in six patients isolated MRSA, Serratia marcescens, Staphylococcus epidermidis, Candida albicans, Anaerococcus, MSSA, and Staphylococcus lugdunensis. The average surgery duration was 240±112 minutes, EBL 296.63±287 ml, LOS 10.5±7.8 days, and mean operative levels 6.9±3.4.
Sixteen patients received gentamycin with beads, 45 received tobramycin, and all received vancomycin. Eight patients had VAC placement, and six required plastic closure. Sixteen (26.23%) patients had surgical site infections (SSI) on admission, with a mean onset of 24.5 days. In patients without previous surgery at the site (27), only two developed infection post-bead placement. In those with prior infections (12), three developed infection post-bead. Nine patients (14.75%) returned to the OR with SSI, 10 (16.39%) had aseptic wound discharge, and four (6.56%) developed seromas, with two requiring aspiration. No postoperative hypercalcemia or acute kidney injury occurred. Complete infection remission was achieved in all but two patients, who expired.
Conclusion : Local antibiotic bead application is an effective adjuvant strategy (along with debridement and systemic antibiotics) for the treatment of spinal SSI. Further studies have to be done to reach affirmative conclusions.
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