Spectrum of Surgical Site Infection Pathogens in Chronic Infectious Spondylitis Requiring Revision Surgery: A 5-Year Cohort Study

Abstract

Background: Spectrum monitoring of the pathogen in spondylitis patients plays a key role in preventing infectious complications of spinal reconstructions in chronic spondylitis (CS) and in the treatment of surgical site infection (SSI). The aim of this study is to characterize the spectrum of SSI pathogens in CS requiring revision surgery. Methods: The primary cohort encompassed 569 surgical patients with infectious CS. In 99 patients (61 men and 38 women) requiring revision surgical interventions due to SSI, continuous microbiological monitoring of the pathogens was conducted. The average age of the patients was 63 ± 14 years. The vast majority of the patients underwent surgery on a set of multilevel (two or more spinal–motor segments) lesions. Lesions of the lumbar spine were more often noted, and lesions of the thoracic, thoracolumbar, and cervical spine sections were less often noted. This study included all patients operated on within the scope of revision spinal reconstructions in connection with the development of infection of the surgical area over the period from January 2018 to December 2022. Inclusion criteria were etiologically verified spondylitis, age of 18 years or older, and follow-up of 6 months or more. Results: The average rate of revision surgery due to SSI was 17.4%. Germ detection from the material of vertebral localization was noted in 48.3% and pathogen strains were isolated in urine in 60.8%, in decubital ulcers in 23.9%, and in hemoculture in 15.2% of all study patients. Aseptic, deep SSI was detected in 10.1%. Gram-positive, multidrug-resistant, and Gram-negative bacteria with extreme resistance prevailed in the microbiological landscape of late SSI, early, and delayed Gram-positive strains without drug resistance. Conclusions: Infectious etiology of spondylitis is associated with a significantly higher frequency of SSI. In the absence of a positive result from bacteriological examination of the vertebral localization material, it is advisable to conduct blood, decubital ulcer discharge, and urine sampling.