Allogenic bone grafts and postoperative surgical site infection: are positive intraoperative swab cultures predictive for a higher infectious risk?
Allograft
Intraoperative swab cultures
Spinal fusion surgery
Spinal postoperative infection
Tissue bank
Journal
Cell and tissue banking
ISSN: 1573-6814
Titre abrégé: Cell Tissue Bank
Pays: Netherlands
ID NLM: 100965121
Informations de publication
Date de publication:
Sep 2023
Sep 2023
Historique:
received:
22
03
2022
accepted:
04
12
2022
medline:
31
8
2023
pubmed:
27
12
2022
entrez:
26
12
2022
Statut:
ppublish
Résumé
In spine surgery, allogenic bone grafts are often required to ensure bone fusion, however, the main concern regarding their use is the infection risk: therefore, an intraoperative swab for culture test is performed. The cost-effectiveness of these swabs and their influence on the patients' postoperative course have often been questioned. This study aims at determining whether positive spine allograft culture results are predictive of an increased risk of surgical site infection and whether they influence the surgeon's choices in postoperative management. The records of 340 patients who received allogenic bone graft during spinal fusion surgery in our institution were reviewed, for a total of 677 allografts. Each graft was swabbed intraoperatively. All patients were followed clinically for postoperative complications. Infection was diagnosed based on clinical data, blood tests and radiographic images, all assessed by an infectious disease specialist. Only 4 of the 677 allografts used (0.6%) resulted positive at the intraoperative swab culture. Three cultures were positive for Staphylococcus epidermidis and one culture for S. warneri. No clinical infection occurred in any of these patients. Twenty-eight of the 340 patients (8.2%) developed an infection, but none of them had a positive intraoperative swab culture. The most common microbiologic pathogen isolated from this cohort was S. aureus. According to our series, intraoperative swab culture results were not predictive for higher risk of infection and did not affect the clinical behavior of the surgeons in postoperative management.
Identifiants
pubmed: 36571669
doi: 10.1007/s10561-022-10061-1
pii: 10.1007/s10561-022-10061-1
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
627-637Informations de copyright
© 2022. The Author(s), under exclusive licence to Springer Nature B.V.
Références
Andrés-Cano P, Cerván A, Rodríguez-Solera M et al (2018) Surgical infection after posterolateral lumbar spine arthrodesis: CT analysis of spinal Fusion. Orthop Surg 10(2):89–97. doi: https://doi.org/10.1111/os.12371
doi: 10.1111/os.12371
pubmed: 29770586
pmcid: 6594514
Barriga A, Díaz-de-Rada P, Barroso JL et al (2004) Frozen cancellous bone allografts: positive cultures of implanted grafts in posterior fusions of the spine. Eur Spine J 13(2):152–156. https://doi.org/10.1007/s00586-003-0633-9
doi: 10.1007/s00586-003-0633-9
pubmed: 14648307
Bartolomeo C, Guimbard Pérez JH, Ortiz PN et al (2018) Fresh frozen allograft in lumbar spine surgery. Does it increase the rate of infection? Rev Asoc Argent Ortop Traumatol 83(3):188–191. https://doi.org/10.15417/issn.1852-7434.2018.83.3.753
doi: 10.15417/issn.1852-7434.2018.83.3.753
Casper DS, Zmistowski B, Hollern DA et al (2018) The effect of postoperative spinal infections on patient mortality. Spine (Phila Pa 1976) 43(3):223–227. doi: https://doi.org/10.1097/BRS.0000000000002277
doi: 10.1097/BRS.0000000000002277
pubmed: 28604484
Centeno JM, Woolf S, Reid JB 3rd, Lubowitz JH (2007) Do anterior cruciate ligament allograft culture results correlate with clinical infections? Arthroscopy 23(10):1100–1103. https://doi.org/10.1016/j.arthro.2007.05.006
doi: 10.1016/j.arthro.2007.05.006
pubmed: 17916476
Couture J, Cabana F (2013) Irradiated allograft bone in spine surgery: to culture or not? A single center retrospective study. Spine (Phila Pa 1976) 38(7):558–563. https://doi.org/10.1097/BRS.0b013e3182761109
doi: 10.1097/BRS.0b013e3182761109
pubmed: 23026873
Davis N, Curry A, Gambhir K et al (1999) Intraoperative bacterial contamination in operations for joint replacement. J Bone Jt Surg Br 81(5):886–889. https://doi.org/10.1302/0301-620x.81b5.9545
doi: 10.1302/0301-620x.81b5.9545
Ehrler DM, Vaccaro AR (2000) The use of allograft bone in lumbar spine surgery. Clin Orthop Relat Res 371:38–45. https://doi.org/10.1097/00003086-200002000-00005
doi: 10.1097/00003086-200002000-00005
Gibson S, McLeod I, Wardlaw D, Urbaniak S (2002) Allograft versus autograft in instrumented posterolateral lumbar spinal fusion: a randomized control trial. Spine (Phila Pa 1976) 27(15):1599–1603. https://doi.org/10.1097/00007632-200208010-00002
doi: 10.1097/00007632-200208010-00002
pubmed: 12163718
Ivory JP, Thomas IH (1993) Audit of a bone bank. J Bone Jt Surg Br 75(3):355–357. https://doi.org/10.1302/0301-620X.75B3.8496199
doi: 10.1302/0301-620X.75B3.8496199
James LA, Ibrahim T, Esler CN (2004) Microbiological culture results for the femoral head. Are they important to the donor? J Bone Jt Surg Ser B 86(6):797–800. https://doi.org/10.1302/0301-620X.86B6.14783
doi: 10.1302/0301-620X.86B6.14783
Karczewski D, Pumberger M, Müller M et al (2020) Implications for diagnosis and treatment of peri-spinal implant infections from experiences in periprosthetic joint infections-a literature comparison and review. J Spine Surg 6(4):800–813. https://doi.org/10.21037/jss-20-12
Karczewski D, Schnake KJ, Osterhoff G et al (2022) Postoperative spinal implant infections (PSII)-A systematic review: what do we know so far and what is critical about it? Glob Spine J 12(6):1231–1246. https://doi.org/10.1177/21925682211024198]
doi: 10.1177/21925682211024198]
Lee CS, Kang KC, Chung SS, Kim KT, Shin SK (2016) Incidence of microbiological contamination of local bone autograft used in posterior lumbar interbody fusion and its association with postoperative spinal infection. J Neurosurg Spine 24(1):20–24. https://doi.org/10.3171/2015.3.SPINE14578
doi: 10.3171/2015.3.SPINE14578
pubmed: 26360142
Mikhael MM, Huddleston PM, Nassr A (2009a) Postoperative culture positive surgical site infections after the use of irradiated allograft, nonirradiated allograft, or autograft for spinal fusion. Spine (Phila Pa 1976) 34(22):2466–2468. doi: https://doi.org/10.1097/BRS.0b013e3181b1fef5
doi: 10.1097/BRS.0b013e3181b1fef5
pubmed: 19829261
Mikhael MM, Huddleston PM, Nassr A et al (2009b) Risk factors for infection after spinal surgery. Spine (Phila Pa 1976) 38(2):188. doi: https://doi.org/10.1097/01.brs.0000166532.58227.4f
doi: 10.1097/01.brs.0000166532.58227.4f
Mroz TE, Joyce MJ, Lieberman IH, Steinmetz MP, Benzel EC, Wang JC (2009) The use of allograft bone in spine surgery: is it safe? Spine J 9(4):303–308. https://doi.org/10.1016/j.spinee.2008.06.452
doi: 10.1016/j.spinee.2008.06.452
pubmed: 18805063
National Nosocomial Infections Surveillance System (2004) National nosocomial infections surveillance (NNIS) system report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 32(8):470–485. https://doi.org/10.1016/S0196655304005425
Palmer SH, Gibbons CLMH, Athanasou NA (1999) The pathology of bone allograft. J Bone Jt Surg Ser B 81(2):333–335. https://doi.org/10.1302/0301-620X.81B2.9320
doi: 10.1302/0301-620X.81B2.9320
Parvizi J, Tan TL, Goswami K et al (2018) The 2018 definition of Periprosthetic hip and knee infection: an evidence-based and validated Criteria. J Arthroplast 33(5):1309-1314e2. https://doi.org/10.1016/j.arth.2018.02.078
doi: 10.1016/j.arth.2018.02.078
Pawar AY, Biswas SK (2016) Postoperative spine infections. Asian Spine J 10(1):176–183. doi: https://doi.org/10.4184/asj.2016.10.1.176
doi: 10.4184/asj.2016.10.1.176
pubmed: 26949475
pmcid: 4764532
Putzier M, Strube P, Funk JF et al (2009) Allogenic versus autologous cancellous bone in lumbar segmental spondylodesis: a randomized prospective study. Eur Spine J 18(5):687–695. https://doi.org/10.1007/s00586-008-0875-7
doi: 10.1007/s00586-008-0875-7
pubmed: 19148687
pmcid: 3234005
Sims L, Kulyk P, Woo A (2017) Intraoperative culture positive allograft bone and subsequent postoperative infections: a retrospective review. Can J Surg 60(2):94–100. doi: https://doi.org/10.1503/cjs.008016
doi: 10.1503/cjs.008016
pubmed: 28234217
pmcid: 5373722
Stepanovic ZLj, Ristic BM (2014) The effectiveness of bone banking in Central Serbia: audit of the first seven years. Cell Tissue Bank 15(4):567–572. https://doi.org/10.1007/s10561-014-9426-0
doi: 10.1007/s10561-014-9426-0
pubmed: 24549703
Tomford WW, Thongphasuk J, Mankin HJ, Ferraro MJ (1990) Frozen musculoskeletal allografts. A study of the clinical incidence and causes of infection associated with their use. J Bone Jt Surg Am 72(8):1137–1143
doi: 10.2106/00004623-199072080-00003
van de Pol GJ, Sturm PD, van Loon CJ, Verhagen C, Schreurs BW (2007) Microbiological cultures of allografts of the femoral head just before transplantation. J Bone Jt Surg Br 89(9):1225–1228. https://doi.org/10.1302/0301-620X.89B9.18864
doi: 10.1302/0301-620X.89B9.18864
Veen MR, Bloem RM, Petit PLC (1994) Sensitivity and negative predictive value of swab cultures in musculoskeletal allograft procurement. Clin Orthop Relat Res 300:259–263. https://doi.org/10.1097/00003086-199403000-00036
doi: 10.1097/00003086-199403000-00036
Villas C, Beguiristain JL, Mora G et al (1996) Aloinjertos en artrodesis vertebrales extensas. Rev Med Univ Navarre 40:15–19