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

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1 Scopus citations

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

Keywords

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

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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    Yoon, J. W., Wanderman, N. R., Kerezoudis, P., Alvi, M. A., De Biase, G., Akinduro, O. O., Berbari, E. F., Bydon, M., & 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