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J Bone Jt Infect. 2018 Dec 24;3(5):266-272. doi: 10.7150/jbji.28765. eCollection 2018.

Relevance of Modified Debridement-Irrigation, Antibiotic Therapy and Implant Retention Protocol for the Management of Surgical Site Infections: A Series of 1694 Instrumented Spinal Surgery.

Author information

1
Department of Neurosurgery B, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France.
2
Department of Neurosurgery, Clinique Mutualiste Chirurgicale, Saint-Etienne, France.
3
Department of Infectious Diseases, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.
4
University Claude Bernard Lyon 1, Lyon, France.
5
Regional reference center for complex bone and joint infections (CRIOAc Lyon), Hospices Civils de Lyon, France.
6
International research center in infectiology, CIRI, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France.
7
Department of Spine Surgery, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France.
8
Department of Anesthesiology, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France.
9
Department of Infectious Diseases Prevention, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France.
10
Laboratory of Biomechanics, Arts et Metiers Paristech, Paris, France.

Abstract

Introduction: Management of surgical site infections (SSI) after instrumented spinal surgery remains controversial. The debridement-irrigation, antibiotic therapy and implant retention protocol (DAIR protocol) is safe and effective to treat deep SSI occurring within the 3 months after instrumented spinal surgery. Methods: This retrospective study describes the outcomes of patients treated over a period of 42 months for deep SSI after instrumented spinal surgery according to a modified DAIR protocol. Results: Among 1694 instrumented surgical procedures, deep SSI occurred in 46 patients (2.7%): 41 patients (89%) experienced early SSI (< 1 month), 3 (7%) delayed SSI (from 1 to 3 months), and 2 (4%) late SSI (> 3months). A total of 37 patients had a minimum 1 year of follow-up; among these the modified DAIR protocol was effective in 28 patients (76%) and failed (need for new surgery for persistent signs of SSI beyond 7 days) in 9 patients (24%). Early second-look surgery (≤ 7days) for iterative debridement was performed in 3 patients, who were included in the cured group. Among the 9 patients in whom the modified DAIR protocol failed, none had early second-look surgery; 3 (33%) recovered and were cured at 1 year follow-up, and 6 (66%) relapsed. Overall, among patients with SSI and a minimum 1 year follow-up, the modified DAIR protocol led to healing in 31/37 (84%) patients. Conclusions: The present study supports the effectiveness of a modified DAIR protocol in deep SSI occurring within the 3 months after instrumented spinal surgery. An early second-look surgery for iterative debridement could increase the success rate of this treatment.

KEYWORDS:

risk factors; spinal surgery; surgical site infection; surgical wound infection

Conflict of interest statement

Competing Interests: The authors have declared that no competing interest exists.

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