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

Research Paper

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

Romain Manet1,2✉, Tristan Ferry3,4,5,6, Jean-Etienne Castelain7, Gilda Pardey Bracho8, Eurico Freitas-Olim7, Jacqueline Grando9, Cédric Barrey4,5,7,10

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

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How to cite this article:
Manet R, Ferry T, Castelain JE, Bracho GP, Freitas-Olim E, Grando J, Barrey C. 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. J Bone Jt Infect 2018; 3(5):266-272. doi:10.7150/jbji.28765. Available from http://www.jbji.net/v03p0266.htm