A potential relationship between postoperative urinary tract infection (UTI) and surgical site infection (SSI) following posterior spinal fusion and instrumentation (PSFI) was investigated.
A retrospective review was performed of prospectively collected demographic, clinical, and microbiological data of 466 consecutive patients (median age 53.7 [IQR 33.8-65.6], 58.6% women) undergoing PSFI to identify those with UTI in the first 4 weeks, and SSI in the first 12 weeks after PSFI. Overall, 40.8% had an ASA score >2, and 49.8% had undergone fusion of more than 3 segments. Eighty-nine patients had UTI, 54 SSI, and 22 presented both conditions. In 9 of the 22 (38%) cases, the two infections were caused by the same microorganism. The urinary tract was the probable source of SSI by gram-negative bacteria in 38% (8/21) of cases. On multivariate analysis, UTI (OR 3.1, 95% CI 1.6-6.1; p=0.001) and instrumentation >3 segments (OR 2.7, 95% CI 1.1-6.3; p=0.024) were statistically associated with SSI. Patients receiving ciprofloxacin for UTI had higher microbial resistance rates to fluoroquinolones at SSI (46.13%) than those without ciprofloxacin (21.9%), although the difference did not reach statistical significance (p=0.1). In our series, UTI was significantly associated with SSI after PSFI. Based on our results, we conclude that further efforts to reduce the incidence of postoperative UTI and provide adequate empirical antibiotic therapy that avoids quinolones whenever possible may help to reduce SSI rates and potential microbial resistances.
Written by:
Núñez-Pereira S, Rodríguez-Pardo D, Pellisé F, Pigrau C, Bagó J, Villanueva C, Cáceres E. Are you the author?
Spine Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Spine Unit, St Franziskus Hospital, Cologne, Germany.
Reference: Clin Microbiol Infect. 2014 Jan 14. Epub ahead of print.
doi: 10.1111/1469-0691.12527
PubMed Abstract
PMID: 24422787
UroToday.com Infections Section
