Abstract #33, titled “Pre-operative decolonization does not adversely affect the microbiologic spectrum of spine surgical site infection ” was presented at the 20th Annual Scientific Conference of the Canadian Spine Society in Whistler, BC on Thursday, February 27, 2020.
Pre-operative decolonization does not adversely affect the microbiologic spectrum of spine surgical site infection
Dr. Supriya Singh1,2, Dr. Alexandra Gara3, Dr. Dan Banaszek1,2, Dr. Titus Wong2, Dr. Tamir Ailon1,2, Dr. Elizabeth Bryce3, Dr. Raphaele Charest-Morin1,2, Dr. Nicolas Dea1,2, Dr. Marcel Dvorak1,2, Dr. Charles Fisher1,2, Dr. Brian Kwon1,2, Dr. Scott Paquette1,2, Dr. John Street1,2
1Vancouver Spine Surgery Institute, Vancouver, British Columbia, Canada. 2University of British Columbia, Vancouver, British Columbia, Canada. 3Infection Control VCH, Vancouver, British Columbia, Canada.
In 2011, a pre-operative decolonization program was introduced for all spine patients, using intranasal photodisinfection therapy, in addition to chlorhexidine-impregnated body wipes (PDT/CHG). This intervention resulted in an absolute risk reduction of 5.2% [spine surgical site infection (SSI) reduction from 7.2% to 2% from 2011-2014]. It is unknown whether such decolonization affects the microbiological spectrum of subsequent surgical site infections, as this could have profound treatment implications. The purpose of this study was to investigate the effect of PDT/CHG on the microbiology of subsequent surgical site infections.
Data was prospectively collected by our institutional SSI surveillance program and our Spine SAVES2 system. We examined SSI organism types for a period prior to PDT/CHG (2010 to August 31st, 2011), and a period post PDT/CHG (2015 to 2018). Cultures from infected sites within a week of symptom onset, as well as within a week before and after a source control procedure, if applicable, were examined for the implicated organism(s).
Of 37 SSIs pre-implementation, 54% of patients had mono-microbial infections with gram-positive organisms (85% were staphylococci), 13% had mono-microbial gram negative infections (all were Enterobacteriaceae), 16% had poly-microbial infections, and the remaining 17% had no growth or no specimens available for analysis.
Among 34 SSIs post-implementation, 59% (n=20) had gram positive organisms (90% were staphylococci), 20% (n=7) had gram negative organisms, 15% (n=5) had polymicrobial infections, and 6% (n=2) had no cultures collected.
In conclusion, based on this small cohort of spine surgery patients, the microbiological spectrum of SSIs was similar pre and post implementation of PDT/CHG. Contrary to other methods, including nasal mupirocin and intra-wound antibiotics, PDT/CHG does not adversely affect the microbiologic spectrum of subsquent infections, while resulting in significant reduction in SSI rates.
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