Enterobacter Infection after Spine Surgery: An Institutional Experience

Jang W. Yoon, Nathan R. Wanderman, Panagiotis Kerezoudis, Mohammed Ali Alvi, Gaetano De Biase, Oluwaseun O. Akinduro, Elie F. Berbari, Mohamad Bydon, Brett Freedman

Research output: Contribution to journalArticle

Abstract

Background: Gram-negative surgical site infections (SSI) following spine surgery are becoming increasingly more common owing to a broad perioperative antibiotic usage targeting gram-positive organisms. Enterobacter species have been reported to be the most common gram-negative bacteria following spine surgery. Methods: We queried our institutional database for Enterobacter SSIs after spine surgery at a single institution from 2009–2016. Relevant demographic, clinical, and operative variables were collected. We compared this cohort to patients who had non-Enterobacter SSI during the same period. Results: Enterobacter species were isolated in 16 patients (9 males) diagnosed with SSI after undergoing spine surgery. This group represented 0.2% of all spine cases and 14.5% of all spinal SSIs. Seven patients (43.8%) required multiple irrigations and debridements (I&Ds) (range: 2–8), whereas only 17 of 94 patients (18.1%) with non-Enterobacter SSI required multiple I&Ds (range: 2–5, P = 0.043). Those infected with Enterobacter were associated with higher BMI (37.6 ± 12.7 vs. 31.7 ± 8, P = 0.036), earlier wound dehiscence (14.8 vs. 24.6 days, P = 0.01), polymicrobial infections (37.5% vs. 10.6%, P = 0.012), and longer length of stay (18 days [9.5–31.5] vs. 5 days [3–8], P = 0.01) when compared to non-Enterobacter SSI cohort. At an average of 24.2 months follow-up, all 15 surviving patients were infection free with no further revision surgeries needed. Conclusions: Enterobacter SSI cases were associated with higher BMI, earlier wound breakdown, polymicrobial infection and longer length of stay. Nevertheless, with vigilant surveillance and timely I&Ds, these challenging infections can be treated successfully with original implant retention in almost all cases.

Original languageEnglish (US)
Pages (from-to)e330-e337
JournalWorld neurosurgery
Volume123
DOIs
StatePublished - Mar 1 2019

Fingerprint

Surgical Wound Infection
Enterobacter
Spine
Infection
Coinfection
Length of Stay
Wounds and Injuries
Debridement
Gram-Negative Bacteria
Reoperation
Demography
Databases
Anti-Bacterial Agents

Keywords

  • Antibiotics
  • Enterobacter
  • Infection
  • Multi-drug resistant
  • Spine surgery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Yoon, J. W., Wanderman, N. R., Kerezoudis, P., Alvi, M. A., De Biase, G., Akinduro, O. O., ... Freedman, B. (2019). Enterobacter Infection after Spine Surgery: An Institutional Experience. World neurosurgery, 123, e330-e337. https://doi.org/10.1016/j.wneu.2018.11.169

Enterobacter Infection after Spine Surgery : An Institutional Experience. / Yoon, Jang W.; Wanderman, Nathan R.; Kerezoudis, Panagiotis; Alvi, Mohammed Ali; De Biase, Gaetano; Akinduro, Oluwaseun O.; Berbari, Elie F.; Bydon, Mohamad; Freedman, Brett.

In: World neurosurgery, Vol. 123, 01.03.2019, p. e330-e337.

Research output: Contribution to journalArticle

Yoon, JW, Wanderman, NR, Kerezoudis, P, Alvi, MA, De Biase, G, Akinduro, OO, Berbari, EF, Bydon, M & Freedman, B 2019, 'Enterobacter Infection after Spine Surgery: An Institutional Experience', World neurosurgery, vol. 123, pp. e330-e337. https://doi.org/10.1016/j.wneu.2018.11.169
Yoon JW, Wanderman NR, Kerezoudis P, Alvi MA, De Biase G, Akinduro OO et al. Enterobacter Infection after Spine Surgery: An Institutional Experience. World neurosurgery. 2019 Mar 1;123:e330-e337. https://doi.org/10.1016/j.wneu.2018.11.169
Yoon, Jang W. ; Wanderman, Nathan R. ; Kerezoudis, Panagiotis ; Alvi, Mohammed Ali ; De Biase, Gaetano ; Akinduro, Oluwaseun O. ; Berbari, Elie F. ; Bydon, Mohamad ; Freedman, Brett. / Enterobacter Infection after Spine Surgery : An Institutional Experience. In: World neurosurgery. 2019 ; Vol. 123. pp. e330-e337.
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title = "Enterobacter Infection after Spine Surgery: An Institutional Experience",
abstract = "Background: Gram-negative surgical site infections (SSI) following spine surgery are becoming increasingly more common owing to a broad perioperative antibiotic usage targeting gram-positive organisms. Enterobacter species have been reported to be the most common gram-negative bacteria following spine surgery. Methods: We queried our institutional database for Enterobacter SSIs after spine surgery at a single institution from 2009–2016. Relevant demographic, clinical, and operative variables were collected. We compared this cohort to patients who had non-Enterobacter SSI during the same period. Results: Enterobacter species were isolated in 16 patients (9 males) diagnosed with SSI after undergoing spine surgery. This group represented 0.2{\%} of all spine cases and 14.5{\%} of all spinal SSIs. Seven patients (43.8{\%}) required multiple irrigations and debridements (I&Ds) (range: 2–8), whereas only 17 of 94 patients (18.1{\%}) with non-Enterobacter SSI required multiple I&Ds (range: 2–5, P = 0.043). Those infected with Enterobacter were associated with higher BMI (37.6 ± 12.7 vs. 31.7 ± 8, P = 0.036), earlier wound dehiscence (14.8 vs. 24.6 days, P = 0.01), polymicrobial infections (37.5{\%} vs. 10.6{\%}, P = 0.012), and longer length of stay (18 days [9.5–31.5] vs. 5 days [3–8], P = 0.01) when compared to non-Enterobacter SSI cohort. At an average of 24.2 months follow-up, all 15 surviving patients were infection free with no further revision surgeries needed. Conclusions: Enterobacter SSI cases were associated with higher BMI, earlier wound breakdown, polymicrobial infection and longer length of stay. Nevertheless, with vigilant surveillance and timely I&Ds, these challenging infections can be treated successfully with original implant retention in almost all cases.",
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AU - Kerezoudis, Panagiotis

AU - Alvi, Mohammed Ali

AU - De Biase, Gaetano

AU - Akinduro, Oluwaseun O.

AU - Berbari, Elie F.

AU - Bydon, Mohamad

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N2 - Background: Gram-negative surgical site infections (SSI) following spine surgery are becoming increasingly more common owing to a broad perioperative antibiotic usage targeting gram-positive organisms. Enterobacter species have been reported to be the most common gram-negative bacteria following spine surgery. Methods: We queried our institutional database for Enterobacter SSIs after spine surgery at a single institution from 2009–2016. Relevant demographic, clinical, and operative variables were collected. We compared this cohort to patients who had non-Enterobacter SSI during the same period. Results: Enterobacter species were isolated in 16 patients (9 males) diagnosed with SSI after undergoing spine surgery. This group represented 0.2% of all spine cases and 14.5% of all spinal SSIs. Seven patients (43.8%) required multiple irrigations and debridements (I&Ds) (range: 2–8), whereas only 17 of 94 patients (18.1%) with non-Enterobacter SSI required multiple I&Ds (range: 2–5, P = 0.043). Those infected with Enterobacter were associated with higher BMI (37.6 ± 12.7 vs. 31.7 ± 8, P = 0.036), earlier wound dehiscence (14.8 vs. 24.6 days, P = 0.01), polymicrobial infections (37.5% vs. 10.6%, P = 0.012), and longer length of stay (18 days [9.5–31.5] vs. 5 days [3–8], P = 0.01) when compared to non-Enterobacter SSI cohort. At an average of 24.2 months follow-up, all 15 surviving patients were infection free with no further revision surgeries needed. Conclusions: Enterobacter SSI cases were associated with higher BMI, earlier wound breakdown, polymicrobial infection and longer length of stay. Nevertheless, with vigilant surveillance and timely I&Ds, these challenging infections can be treated successfully with original implant retention in almost all cases.

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KW - Spine surgery

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