JBJI Journal of Bone and Joint Infection JBJI J. Bone Joint Infect. 2206-3552 Ivyspring Göttingen, Germany 10.7150/jbji.28765 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 Manet Romain 1 2 Ferry Tristan 3 4 5 6 Castelain Jean-Etienne 7 Bracho Gilda Pardey 8 Freitas-Olim Eurico 7 Grando Jacqueline 9 Barrey Cédric 4 5 7 10 Department of Neurosurgery B, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France Department of Neurosurgery, Clinique Mutualiste Chirurgicale, Saint-Etienne, France Department of Infectious Diseases, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France University Claude Bernard Lyon 1, Lyon, France Regional reference center for complex bone and joint infections (CRIOAc Lyon), Hospices Civils de Lyon, France International research center in infectiology, CIRI, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France Department of Spine Surgery, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France Department of Anesthesiology, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France Department of Infectious Diseases Prevention, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France Laboratory of Biomechanics, Arts et Metiers Paristech, Paris, France 24 12 2018 3 5 266 272 Copyright: © 2018 Romain Manet et al. 2018 This work is licensed under the Creative Commons Attribution 4.0 International License. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/ This article is available from https://jbji.copernicus.org/articles/3/266/2018/jbji-3-266-2018.html The full text article is available as a PDF file from https://jbji.copernicus.org/articles/3/266/2018/jbji-3-266-2018.pdf

<p class="p p-first" id="__p2"><strong>Introduction:</strong> 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.</p><p id="__p3"><strong>Methods:</strong> 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.</p><p id="__p4"><strong>Results:</strong> Among 1694 instrumented surgical procedures, deep SSI occurred in 46 patients (2.7%): 41 patients (89%) experienced early SSI (&lt; 1 month), 3 (7%) delayed SSI (from 1 to 3 months), and 2 (4%) late SSI (&gt; 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.</p><p class="p p-last" id="__p5"><strong>Conclusions:</strong> 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.</p>

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