Journal Article

The Management and Outcome of Spinal Implant Infections: Contemporary Retrospective Cohort Study

Todd J. Kowalski, Elie F. Berbari, Paul M. Huddleston, James M. Steckelberg, Jayawant N. Mandrekar and Douglas R. Osmon

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 44, issue 7, pages 913-920
Published in print April 2007 | ISSN: 1058-4838
Published online April 2007 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/512194
The Management and Outcome of Spinal Implant Infections: Contemporary Retrospective Cohort Study

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  • Infectious Diseases
  • Immunology
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Background. Spinal implant infections provide unique diagnostic and therapeutic challenges.

Methods. We conducted a retrospective cohort study to evaluate risk factors for treatment failure in patients with early- and late- onset spinal implant infections at the Mayo Clinic (Rochester, MN) during 1994–2002.

Results. We identified 30 patients with early-onset spinal implant infection and 51 patients with late-onset spinal implant infection. Twenty-eight of 30 patients with early-onset infection were treated with debridement, implant retention, and antimicrobial therapy. The estimated 2-year cumulative probability of survival free of treatment failure for patients with early-onset infection was 71% (95% confidence interval [CI], 51%–85%). Thirty-two of 51 patients with late-onset infection were treated with implant removal. Their estimated 2-year cumulative probability of survival free of treatment failure was 84% (95% CI, 66%–93%). For patients with early-onset infections, receiving oral antimicrobial suppression therapy was associated with increased cumulative probability of survival (hazard ratio, 0.2; 95% CI, 0.1–0.7). For patients with late-onset infections, implant removal was associated with increased cumulative probability of survival (hazard ratio, 0.3; 95% CI, 0.1–0.7).

Conclusions. Early-onset spinal implant infections are successfully treated with debridement, implant retention, and parenteral followed by oral suppressive antimicrobial therapy. Implant removal is associated with successful outcomes in late-onset infections.

Journal Article.  3558 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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