Skip to main content
Erschienen in: European Spine Journal 12/2016

27.06.2016 | Original Article

Risk factors for surgical site infection and urinary tract infection after spine surgery

verfasst von: Hiroyuki Tominaga, Takao Setoguchi, Yasuhiro Ishidou, Satoshi Nagano, Takuya Yamamoto, Setsuro Komiya

Erschienen in: European Spine Journal | Ausgabe 12/2016

Einloggen, um Zugang zu erhalten

Abstract

Purpose

This study aimed to identify and compare risk factors for surgical site infection (SSI) and non-surgical site infections (non-SSIs), particularly urinary tract infection (UTI), after spine surgery.

Methods

We retrospectively reviewed 825 patients (median age 59.0 years (range 33–70 years); 442 males) who underwent spine surgery at Kagoshima University Hospital from January 2009 to December 2014. Patient parameters were compared using the Mann–Whitney U and Fisher’s exact tests. Risk factors associated with SSI and UTI were analyzed via the multiple logistic regression analysis. P < 0.05 was considered statistically significant.

Results

SSI occurred in 14 of 825 cases (1.7 %), and non-SSI occurred in 23 of 825 cases (2.8 %). Most non-SSIs were UTIs (20 of 23 cases, 87.0 %). In the 14 patients with SSI, UTI occurred before SSI onset in one patient, and after SSI onset in two patients. UTI onset before SSI was not a risk factor for SSI. Multiple logistic regression analysis indicated that common risk factors for SSI and UTI were operation time (P = 0.0019 and 0.0162, respectively) and ASA classification 3 (P = 0.0132 and 0.0356, respectively). The 1 week post-operative C-reactive protein (CRP) level was a risk factor for UTI (P = 0.0299), but not for SSI (P = 0.4996).

Conclusions

There was no relationship between SSI and symptomatic UTI after spine surgery. Risk factors for post-operative SSI and UTI were operative time and ASA classification 3; 1 week post-operative CRP was a risk factor for UTI only.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Koutsoumbelis S, Hughes AP, Girardi FP, Cammisa FP Jr, Finerty EA, Nguyen JT, Gausden E, Sama AA (2011) Risk factors for postoperative infection following posterior lumbar instrumented arthrodesis. J Bone Jt Surg Am 93:1627–1633. doi:10.2106/JBJS.J.00039 CrossRef Koutsoumbelis S, Hughes AP, Girardi FP, Cammisa FP Jr, Finerty EA, Nguyen JT, Gausden E, Sama AA (2011) Risk factors for postoperative infection following posterior lumbar instrumented arthrodesis. J Bone Jt Surg Am 93:1627–1633. doi:10.​2106/​JBJS.​J.​00039 CrossRef
3.
4.
Zurück zum Zitat Nunez-Pereira S, Rodriguez-Pardo D, Pellise F, Pigrau C, Bago J, Villanueva C, Caceres E (2014) Postoperative urinary tract infection and surgical site infection in instrumented spinal surgery: is there a link? Clin Microbiol Infect 20:768–773. doi:10.1111/1469-0691.12527 CrossRefPubMed Nunez-Pereira S, Rodriguez-Pardo D, Pellise F, Pigrau C, Bago J, Villanueva C, Caceres E (2014) Postoperative urinary tract infection and surgical site infection in instrumented spinal surgery: is there a link? Clin Microbiol Infect 20:768–773. doi:10.​1111/​1469-0691.​12527 CrossRefPubMed
6.
Zurück zum Zitat Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR (1999) Guideline for Prevention of Surgical Site Infection, 1999 Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control 27:97–132 (quiz 133–134; discussion 196)CrossRefPubMed Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR (1999) Guideline for Prevention of Surgical Site Infection, 1999 Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control 27:97–132 (quiz 133–134; discussion 196)CrossRefPubMed
8.
Zurück zum Zitat Weiss M, Huber-Lang M, Taenzer M, Traeger K, Altherr J, Kron M, Hay B, Schneider M (2009) Different patient case mix by applying the 2003 SCCM/ESICM/ACCP/ATS/SIS sepsis definitions instead of the 1992 ACCP/SCCM sepsis definitions in surgical patients: a retrospective observational study. BMC Med Inform Decis Mak 9:25. doi:10.1186/1472-6947-9-25 CrossRefPubMedPubMedCentral Weiss M, Huber-Lang M, Taenzer M, Traeger K, Altherr J, Kron M, Hay B, Schneider M (2009) Different patient case mix by applying the 2003 SCCM/ESICM/ACCP/ATS/SIS sepsis definitions instead of the 1992 ACCP/SCCM sepsis definitions in surgical patients: a retrospective observational study. BMC Med Inform Decis Mak 9:25. doi:10.​1186/​1472-6947-9-25 CrossRefPubMedPubMedCentral
9.
Zurück zum Zitat Dubory A, Giorgi H, Walter A, Bouyer B, Vassal M, Zairi F, Dhenin A, Grelat M, Lonjon N, Dauzac C, Lonjon G (2015) Surgical-site infection in spinal injury: incidence and risk factors in a prospective cohort of 518 patients. Eur Spine J 24:543–554. doi:10.1007/s00586-014-3523-4 CrossRefPubMed Dubory A, Giorgi H, Walter A, Bouyer B, Vassal M, Zairi F, Dhenin A, Grelat M, Lonjon N, Dauzac C, Lonjon G (2015) Surgical-site infection in spinal injury: incidence and risk factors in a prospective cohort of 518 patients. Eur Spine J 24:543–554. doi:10.​1007/​s00586-014-3523-4 CrossRefPubMed
10.
Zurück zum Zitat Xing D, Ma JX, Ma XL, Song DH, Wang J, Chen Y, Yang Y, Zhu SW, Ma BY, Feng R (2013) A methodological, systematic review of evidence-based independent risk factors for surgical site infections after spinal surgery. Eur Spine J 22:605–615. doi:10.1007/s00586-012-2514-6 CrossRefPubMed Xing D, Ma JX, Ma XL, Song DH, Wang J, Chen Y, Yang Y, Zhu SW, Ma BY, Feng R (2013) A methodological, systematic review of evidence-based independent risk factors for surgical site infections after spinal surgery. Eur Spine J 22:605–615. doi:10.​1007/​s00586-012-2514-6 CrossRefPubMed
11.
Zurück zum Zitat Mirza SK, Deyo RA, Heagerty PJ, Konodi MA, Lee LA, Turner JA, Goodkin R (2008) Development of an index to characterize the “invasiveness” of spine surgery: validation by comparison to blood loss and operative time. Spine (Phila Pa 1976) 33:2651–2661. doi:10.1097/BRS.0b013e31818dad07 (discussion 2662) CrossRef Mirza SK, Deyo RA, Heagerty PJ, Konodi MA, Lee LA, Turner JA, Goodkin R (2008) Development of an index to characterize the “invasiveness” of spine surgery: validation by comparison to blood loss and operative time. Spine (Phila Pa 1976) 33:2651–2661. doi:10.​1097/​BRS.​0b013e31818dad07​ (discussion 2662) CrossRef
12.
14.
15.
Zurück zum Zitat Lonjon G, Dauzac C, Fourniols E, Guigui P, Bonnomet F, Bonnevialle P, French Orthopaedic Surgery Traumatology S (2012) Early surgical site infections in adult spinal trauma: a prospective, multicentre study of infection rates and risk factors. Orthop Traumatol Surg Res 98:788–794. doi:10.1016/j.otsr.2012.07.006 CrossRefPubMed Lonjon G, Dauzac C, Fourniols E, Guigui P, Bonnomet F, Bonnevialle P, French Orthopaedic Surgery Traumatology S (2012) Early surgical site infections in adult spinal trauma: a prospective, multicentre study of infection rates and risk factors. Orthop Traumatol Surg Res 98:788–794. doi:10.​1016/​j.​otsr.​2012.​07.​006 CrossRefPubMed
17.
Zurück zum Zitat Schoenfeld AJ, Carey PA, Cleveland AW 3rd, Bader JO, Bono CM (2013) Patient factors, comorbidities, and surgical characteristics that increase mortality and complication risk after spinal arthrodesis: a prognostic study based on 5,887 patients. Spine J 13:1171–1179. doi:10.1016/j.spinee.2013.02.071 CrossRefPubMed Schoenfeld AJ, Carey PA, Cleveland AW 3rd, Bader JO, Bono CM (2013) Patient factors, comorbidities, and surgical characteristics that increase mortality and complication risk after spinal arthrodesis: a prognostic study based on 5,887 patients. Spine J 13:1171–1179. doi:10.​1016/​j.​spinee.​2013.​02.​071 CrossRefPubMed
18.
Zurück zum Zitat Muilwijk J, Walenkamp GH, Voss A, Wille JC, van den Hof S (2006) Random effect modelling of patient-related risk factors in orthopaedic procedures: results from the Dutch nosocomial infection surveillance network ‘PREZIES’. J Hosp Infect 62:319–326. doi:10.1016/j.jhin.2005.08.006 CrossRefPubMed Muilwijk J, Walenkamp GH, Voss A, Wille JC, van den Hof S (2006) Random effect modelling of patient-related risk factors in orthopaedic procedures: results from the Dutch nosocomial infection surveillance network ‘PREZIES’. J Hosp Infect 62:319–326. doi:10.​1016/​j.​jhin.​2005.​08.​006 CrossRefPubMed
19.
Zurück zum Zitat Mehta AI, Babu R, Karikari IO, Grunch B, Agarwal VJ, Owens TR, Friedman AH, Bagley CA, Gottfried ON (2012) 2012 Young Investigator Award winner: The distribution of body mass as a significant risk factor for lumbar spinal fusion postoperative infections. Spine (Phila Pa 1976) 37:1652–1656. doi:10.1097/BRS.0b013e318241b186 CrossRef Mehta AI, Babu R, Karikari IO, Grunch B, Agarwal VJ, Owens TR, Friedman AH, Bagley CA, Gottfried ON (2012) 2012 Young Investigator Award winner: The distribution of body mass as a significant risk factor for lumbar spinal fusion postoperative infections. Spine (Phila Pa 1976) 37:1652–1656. doi:10.​1097/​BRS.​0b013e318241b186​ CrossRef
20.
Zurück zum Zitat Rasouli MR, Restrepo C, Maltenfort MG, Purtill JJ, Parvizi J (2014) Risk factors for surgical site infection following total joint arthroplasty. J Bone Jt Surg Am 96:e158. doi:10.2106/JBJS.M.01363 CrossRef Rasouli MR, Restrepo C, Maltenfort MG, Purtill JJ, Parvizi J (2014) Risk factors for surgical site infection following total joint arthroplasty. J Bone Jt Surg Am 96:e158. doi:10.​2106/​JBJS.​M.​01363 CrossRef
21.
Zurück zum Zitat Bohl DD, Ahn J, Tabaraee E, Ahn J, Jain A, Grauer JN, Singh K (2015) Urinary tract infection following posterior lumbar fusion procedures: an ACS-NSQIP study. Spine (Phila Pa 1976). doi:10.1097/BRS.0000000000001003 Bohl DD, Ahn J, Tabaraee E, Ahn J, Jain A, Grauer JN, Singh K (2015) Urinary tract infection following posterior lumbar fusion procedures: an ACS-NSQIP study. Spine (Phila Pa 1976). doi:10.​1097/​BRS.​0000000000001003​
23.
Zurück zum Zitat Omeis IA, Dhir M, Sciubba DM, Gottfried ON, McGirt MJ, Attenello FJ, Wolinsky JP, Gokaslan ZL (2011) Postoperative surgical site infections in patients undergoing spinal tumor surgery: incidence and risk factors. Spine (Phila Pa 1976) 36:1410–1419. doi:10.1097/BRS.0b013e3181f48fa9 CrossRef Omeis IA, Dhir M, Sciubba DM, Gottfried ON, McGirt MJ, Attenello FJ, Wolinsky JP, Gokaslan ZL (2011) Postoperative surgical site infections in patients undergoing spinal tumor surgery: incidence and risk factors. Spine (Phila Pa 1976) 36:1410–1419. doi:10.​1097/​BRS.​0b013e3181f48fa9​ CrossRef
24.
Zurück zum Zitat Kawamura H, Matsumoto K, Shigemi A, Orita M, Nakagawa A, Nozima S, Tominaga H, Setoguchi T, Komiya S, Tokuda K, Nishi J (2015) A bundle that includes active surveillance, contact precaution for carriers, and cefazolin-based antimicrobial prophylaxis prevents methicillin-resistant Staphylococcus aureus infections in clean orthopedic surgery. Am J Infect Control. doi:10.1016/j.ajic.2015.09.014 Kawamura H, Matsumoto K, Shigemi A, Orita M, Nakagawa A, Nozima S, Tominaga H, Setoguchi T, Komiya S, Tokuda K, Nishi J (2015) A bundle that includes active surveillance, contact precaution for carriers, and cefazolin-based antimicrobial prophylaxis prevents methicillin-resistant Staphylococcus aureus infections in clean orthopedic surgery. Am J Infect Control. doi:10.​1016/​j.​ajic.​2015.​09.​014
25.
Zurück zum Zitat Hooton TM, Bradley SF, Cardenas DD, Colgan R, Geerlings SE, Rice JC, Saint S, Schaeffer AJ, Tambayh PA, Tenke P, Nicolle LE, Infectious Diseases Society of A (2010) Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis 50:625–663CrossRefPubMed Hooton TM, Bradley SF, Cardenas DD, Colgan R, Geerlings SE, Rice JC, Saint S, Schaeffer AJ, Tambayh PA, Tenke P, Nicolle LE, Infectious Diseases Society of A (2010) Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis 50:625–663CrossRefPubMed
Metadaten
Titel
Risk factors for surgical site infection and urinary tract infection after spine surgery
verfasst von
Hiroyuki Tominaga
Takao Setoguchi
Yasuhiro Ishidou
Satoshi Nagano
Takuya Yamamoto
Setsuro Komiya
Publikationsdatum
27.06.2016
Verlag
Springer Berlin Heidelberg
Erschienen in
European Spine Journal / Ausgabe 12/2016
Print ISSN: 0940-6719
Elektronische ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-016-4674-2

Weitere Artikel der Ausgabe 12/2016

European Spine Journal 12/2016 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.