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Journal of Bone and Joint Infection An open-access journal of the European Bone and Joint Infection Society and the MusculoSkeletal Infection Society
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Volume 3, issue 5
J. Bone Joint Infect., 3, 266–272, 2018
https://doi.org/10.7150/jbji.28765
© Author(s) 2018. This work is distributed under
the Creative Commons Attribution 4.0 License.
J. Bone Joint Infect., 3, 266–272, 2018
https://doi.org/10.7150/jbji.28765
© Author(s) 2018. This work is distributed under
the Creative Commons Attribution 4.0 License.

Original full-length article 24 Dec 2018

Original full-length article | 24 Dec 2018

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, and Cédric Barrey4,5,7,10 Romain Manet et al.
  • 1Department of Neurosurgery B, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
  • 2Department of Neurosurgery, Clinique Mutualiste Chirurgicale, Saint-Etienne, France
  • 3Department of Infectious Diseases, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
  • 4University Claude Bernard Lyon 1, Lyon, France
  • 5Regional reference center for complex bone and joint infections (CRIOAc Lyon), Hospices Civils de Lyon, France
  • 6International research center in infectiology, CIRI, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France
  • 7Department of Spine Surgery, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
  • 8Department of Anesthesiology, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
  • 9Department of Infectious Diseases Prevention, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
  • 10Laboratory of Biomechanics, Arts et Metiers Paristech, Paris, France

Keywords: risk factors, spinal surgery, surgical site infection, surgical wound infection

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.

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