Ufuk TALU, S. Bora GÖKSAN, Cüneyt ŞAR, Azmi HAMZAOĞLU, Ünsal DOMANİÇ

Posterior spinal enstrümantasyon sonrasında erken derin enfeksiyon ve tedavi yaklaşımı

Amaç: Posterior spinal füzyon ve enstrümantasyon sonrasında erken derin enfeksiyon gelişen olgularda risk faktörlerini, önlemleri ve ideal tedavi yaklaşımını değerlendirmek. Çalışma planı: Sekiz olgu ilk ameliyat öncesi risk faktörleri, cerrahi tedavi gerektiren problem, enfeksiyonun başlangıcı, başvuru şekli, düzenli aralıklarla izlenen laboratuar değerleri (serum total protein ve albumin seviyesi, lökosit sayısı, eritrosit sedimantasyon hızı, CRP seviyesi) ve sonuçlar açısından değerlendirildi. Tüm olgularda ilk cerrahi alanın tamamı açılarak debridman protokolü uygulandı. En az bir yıl süreyle klinik ve laboratuvar olarak enfeksiyon bulguları saptanmaması iyileşme kabul edildi. Hastalar ortalama 31 ay süreyle takip edildi. Sonuçlar: Hastaların enfeksiyon ile başvurdukları süre, ilk cerrahi girişimden sonra ortalama 17 gündü. Sorumlu mikroorganizma dört olguda metisiline dirençli Staphylococcus aureus, birer olguda Acinetobacter, Enterobacter, gram-negatif çomak ve Klebsiella pneumoniae şeklindeydi. Ortalama serum albumin düzeyi başvuru anında 2.9 gr/100 ml bulundu; lökosit sayısı üç hastada hafif yüksek, sedimantasyon hızı ortalama 78 mm/saat ve CRP düzeyi 106 mg/lt idi. Cerrahi debridmandan sonra CRP düzeyinde hızlı ve düzenli düşüş görüldü. Olguların hiçbirinde enstrümanın çıkarılması gerekmedi ve tümünde radyolojik füzyon gözlendi. Çıkarımlar: Ameliyat sonrası enfeksiyonların önlenmesi ve tedavisinde tüm risk faktörlerinin iyi değerlendirilmesi gerekir. CRP seviyesi erken tanı ve tedaviye yanıtın değerlendirilmesi açısından son derece önemlidir. Enstrüman zemininde gelişen erken derin enfeksiyon durumunda ameliyat bölgesinin tümü boyunca agresif bir debridman yapılmalıdır.

Anahtar Kelimeler:

Ortopedik fiksasyon araçları, Ameliyat sonrası komplikasyonlar, Risk faktörleri, İnternal fiksatörler, Debridman, Cerrahi yara enfeksiyonu, Omurilik füzyonu, Omurilik hastalıkları, Enfeksiyon, Ortopedik işlemler

Early deep postoperative wound infection after posterior instrumentation of the spine and its treatment

Objectives: To evaluate risk factors, preventive measures and proper treatment approach in patients who develop early deep infection after posterior spinal instrumentation and fusion. Methods: Eight patients were analyzed with regard to preoperative risk factors, original diagnoses requiring surgery, onset of infection, presentation, laboratory findings obtained at regular intervals (serum total protein and albumin, leukocyte count, erythrocyte sedimentation rate, and CRP), and treatment outcome. All patients underwent an aggressive debridement protocol.Cure was defined as lack of clinical and laboratory findings suggesting infection for a duration of at least a year. Mean follow-up was 31 months. Results: All patients presented after a mean of 17 days from the initial surgery. Methicillin-resistant Staphylococcus aureus was detected in four patients; Acinetobacter, Enterobacter, gram-negative rods and Klepsiella pneumoniae were found in the remaining four patients, respectively. At presentation, mean serum a lbumin level was 2.9 g/100 ml; leukocyte count was minimally elevated in three patients, mean erythrocyte sedimentation rate was 78 mm/h and CRP level was 106 mg/L. CRP levels exhibited rapid and consistent decrease after surgical debridement. Radiologic fusion was achieved in all patients without the need for removal of instrumentation. Conclusion: All risk factors should be carefully evaluated in both prevention and treatment of postoperative spine infections. Monitoring CRP levels may be of great help in early diagnosis and treatment of postoperative infections. Early deep wound infections associated with instumentation require an aggressive debridement of the entire wound site.

Keywords:

Orthopedic Fixation Devices, Postoperative Complications, Risk Factors, Internal Fixators, Debridement, Surgical Wound Infection, Spinal Fusion, Spinal Diseases, Infection, Orthopedic Procedures,

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