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DOI: 10.1055/a-1800-7797
Postoperative Wundinfektionen – Zusammenfassung und Überblick
Postoperative wound infections – Abstract and Summary![](https://www.thieme-connect.de/media/10.1055-s-00033104/202204/lookinside/thumbnails/cme_18007797_rickert_10-1055-a-1800-7797-1.jpg)
Iatrogene Wundinfektionen gehören zu den häufigsten Komplikationen in der Wirbelsäulenchirurgie. Für betroffene Patienten bedeutet eine Wundinfektion aufgrund des prolongierten Heilverlaufs eine sehr hohe physische und psychische Belastung. Die entsprechende Prävention, präoperative Optimierung der Patienten sowie die Therapiemaßnahmen sind nach wie vor hochaktuell, gerade im Zeitalter der Antibiotikatherapie.
Abstract
Postoperative wound infections of the spine are among the most common complications in spine surgery. Preoperative assessment of risk factors, classification of the infection, and diagnostics as well as treatment concepts must be considered. Currently, there are no generally accepted guidelines or therapeutical convention in the literature for the standardized treatment of wound infections. The depth of the infection plays a major role in the choice of therapy. A distinction is made between epifascial and subfascial infections, as well as early and late infections. The interaction between surgical measures and accompanying microbiological antibiotic administration is the basis of the therapy.
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Postoperative Wundinfektionen sind eine der häufigsten Komplikationen in der Wirbelsäulenchirurgie.
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Oftmals sind zahlreiche Folgeeingriffe erforderlich, bis die infizierte Wunde ausreichend therapiert ist. Für den Patienten bedeutet dies einen langen Leidensweg mit entsprechender physischer und psychischer Belastung.
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Postoperative Wundinfektionen bei Wirbelsäuleneingriffen <6 Wochen werden als „early Onset Infection“ >6 Wochen als „late Onset Infection“ definiert.
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Die Indikation zur Wundrevision bei klinischem Verdacht auf eine Wundinfektion ist frühzeitig zu stellen – kein „wait and see“!
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Wichtigste Maßnahmen der Behandlung sind das chirurgische Débridement mit Wundspülung und eine antibiogrammgerechte antibiotische Therapie.
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Die VAC-Behandlung ist ein zuverlässiges Hilfsmittel in der Infektbehandlung bei tiefen Infektionen und Frühinfektionen.
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Auch weiterhin existieren aufgrund der nicht eindeutigen Studienlage noch keine einheitlichen Therapierichtlinien.
Schlüsselwörter
Postoperative Wundinfektion - Revisionsoperationen - Komplikationen - Infektion - WirbelsäulePublication History
Article published online:
14 November 2022
© 2022. Thieme. All rights reserved.
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Literatur
- 1 Beiner JM, Grauer J, Kwon BK. et al. Postoperative wound infections of the spine. Neurosurg Focus 2003; 15: 1-5 DOI: 10.3171/foc.2003.15.3.14. (PMID: 15347232)
- 2 DiPaola CP, Saravanja DD, Boriani L. et al. Postoperative Infection Treatment Score for the Spine (PITSS): construction and validation of a predictive model to define need for single versus multiple irrigation and debridement for spinal surgical site infection. Spine J 2012; 12: 218-230 DOI: 10.1016/j.spinee.2012.02.004. (PMID: 22386957)
- 3 Galway UA, Parker BM, Borkowski RG. Prevention of postoperative surgical site infections. Int Anesthesiol Clin 2009; 47: 37-53 DOI: 10.1097/aia.0b013e3181b48761. (PMID: 19820477)
- 4 Ryang YM, Akbar M. Die eitrige Spondylodiszitis: Symptome, Diagnostik und Behandlungsstrategien. Orthopäde 2020; 49: 691-701 DOI: 10.1007/s00132-020-03945-1.
- 5 Barrey C, Launay O, Freitas E. et al. The follow-up of patients with postoperative infection of the spine. Eur J Orthop Surg Traumatol 2013; 23: 29-34 DOI: 10.1007/s00590-013-12. (PMID: 23712673)
- 6 Shillingford JN, Laratta JL, Reddy H. et al. Postoperative surgical site infection after spine surgery: an update from the Scoliosis Research Society (SRS) morbidity and mortality database*. Spine Deform 2018; 6: 634-643 DOI: 10.1016/j.jspd.2018.04.004. (PMID: 30348337)
- 7 Ojo O, Owolabi B, Oseni A. et al. Surgical site infection in posterior spine surgery. Niger J Clin Pract 2016; 19: 821 DOI: 10.4103/1119-3077.183237. (PMID: 27811458)
- 8 Hachenberg T, Sentürk M, Jannasch O. et al. Postoperative Wundinfektionen. Anaesthesist 2012; 59: 851-868 DOI: 10.1007/s00101-010-1789-4.
- 9 Rickert M, Fleege C, Rauschmann M. Algorithm for treatment of spinal infections and first results of a retrospective analysis of postoperative wound infection an application of a vacuum system for infection treatment. Die Wirbelsäule 2017; 01: 265-272
- 10 DWG Register Zugriff am 22.04.2021. Accessed September 13, 2022 at: https://dwg.memdoc.org/home.jsf
- 11 Palmowski Y, Bürger J, Kienzle A. et al. Antibiotic treatment of postoperative spinal implant infections. J Spine Surg 2020; 6: 785-792 DOI: 10.21037/jss-20-456. (PMID: 33447684)
- 12 Bullmann V. Evidence-based implant choice in infections of the spine: is it a gut thing, after all?. Orthopäde 2020; 49: 685-690 DOI: 10.1007/s00132-020-03955-z. (PMID: 32661896)
- 13 Zippelius T, Bürger J, Schömig F. et al. Clinical presentation and diagnosis of acute postoperative spinal implant infection (PSII). J Spine Surg 2020; 6: 765-771 DOI: 10.21037/jss-20-587. (PMID: 33447681)
- 14 Rickert M, Schleicher P, Fleege C. et al. Management of postoperative wound infections following spine surgery: first results of a multicenter study. Orthopäde 2016; 45: 780-788 DOI: 10.1007/s00132-016-3314-1. (PMID: 27514826)
- 15 Akbar M, Lehner B, Ryang YM. Low-grade-infections after spondylodeses – A chameleon? Current findings and therapeutic strategies . Orthopäde 2020; 49: 669-678 DOI: 10.1007/s00132-020-03947-z. (PMID: 32676718)
- 16 Chang HK, Huang WC, Wu JC. Commentary: low-grade infection and implant failure following spinal instrumentation: a prospective comparative study. Neurosurgery 2020; 87: E541-E542 DOI: 10.1093/neuros/nyaa160. (PMID: 32409829)
- 17 Shiban E, Joerger AK, Janssen I. et al. Low-grade infection and implant failure following spinal instrumentation: a prospective comparative study. Neurosurgery 2020; 87: 964-970 DOI: 10.1093/neuros/nyaa133. (PMID: 32409827)
- 18 DZIF. Biofilm. Accessed September 13, 2022 at: https://www.dzif.de/de/glossar/biofilm
- 19 Zhou J, Wang R, Huo X. et al. Incidence of surgical site infection after spine surgery: a systematic review and meta-analysis. Spine 2020; 45: 208-216 DOI: 10.1097/BRS.0000000000003218. (PMID: 31464972)
- 20 Bürger J, Akgün D, Strube P. et al. Sonication of removed implants improves microbiological diagnosis of postoperative spinal infections. Eur Spine J 2019; 28: 768-774 DOI: 10.1007/s00586-019-05881-x. (PMID: 30656472)
- 21 Peng XQ, Sun CG, Fei ZG. et al. Risk factors for surgical site infection after spinal surgery: a systematic review and meta-analysis based on twenty-seven studies. World Neurosurg 2019; 123: e318-e329 DOI: 10.1016/j.wneu.2018.11.158. (PMID: 30496932)
- 22 Agarwal A, Lin B, Agarwal AG. et al. A multicenter trial demonstrating presence or absence of bacterial contamination at the screwbone interface owing to absence or resence of pedicle screw guard, respectively, during spinalfusion. Clin Spine Surg 2020; 33: E364-E368 DOI: 10.1097/bsd.0000000000000976. (PMID: 32168115)
- 23 Jägersberg M, Feihl S, Ringel F. Future directions of postoperative spinal implant infections. J Spine Surg 2020; 6: 814-819 DOI: 10.21037/jss-20-585. (PMID: 33447687)
- 24 Li S, Rong H, Zhang X. et al. Meta-analysis of topical vancomycin powder for microbial profile in spinal surgical site infections. Eur Spine J 2019; 28: 2972-2980 DOI: 10.1007/s00586-019-06143-6. (PMID: 31522274)
- 25 Di Silvestre M, Bakaloudis G, Lolli F. et al. Late-developing infection following posterior fusion for adolescent idiopathic scoliosis. Eur Spine J 2011; 20 (Suppl. 01) S121-S127 DOI: 10.1007/s00586-011-1754-1.
- 26 Carlson BC, Hines JT, Robinson WA. et al. Implant sonication versus tissue culture for the diagnosis of spinal implant infection. Spine 2020; 45: E525-E532 DOI: 10.1097/BRS.0000000000003311. (PMID: 32282655)
- 27 Schwyzer M, Martini K, Benz DC. et al. Artificial intelligence for detecting small FDG-positive lung nodules in digital PET/CT: impact of image reconstructions on diagnostic performance. Eur Radiol 2020; 30: 2031-2040 DOI: 10.1007/s00330-019-06498-w. (PMID: 31822970)
- 28 Pennington Z, Sundar SJ, Lubelski D. et al. Cost and quality of life outcome analysis of postoperative infections after posterior lumbar decompression and fusion. J Clin Neurosci 2019; 68: 105-110 DOI: 10.1016/j.jocn.2019.07.025. (PMID: 31350079)
- 29 De Winter F, Gemmel F, Van De Wiele C. et al. 18-Fluorine fluorodeoxyglucose positron emission tomography for the diagnosis of infection in the postoperative spine. Spine 2003; 28: 1314-1319 DOI: 10.1097/01.BRS.0000065483.07790.34.
- 30 Casali M, Lauri C, Altini C. et al. State of the art of 18F-FDG PET/CT application in inflammation and infection: a guide for image acquisition and interpretation. Clin Transl Imaging 2021; 9: 299-339 DOI: 10.1007/s40336-021-00445-w. (PMID: 34277510)
- 31 Smids C, Kouijzer IJ, Vos FJ. et al. A comparison of the diagnostic value of MRI and 18F-FDG-PET/CT in suspected spondylodiscitis. Infection 2017; 45: 41-49 DOI: 10.1007/s15010-016-0914-y. (PMID: 27317050)
- 32 Hungenbach S, Delank KS, Dietlein M. et al. 18F-fluorodeoxyglucose uptake pattern in patients with suspected spondylodiscitis. Nucl Med Commun 2013; 34: 1068-1074 DOI: 10.1097/MNM.0b013e328365abec. (PMID: 24025917)
- 33 Lee MJ, Cizik AM, Hamilton D. et al. Predicting surgical site infection after spine surgery: a validated model using a prospective surgical registry. Spine J 2014; 14: 2112-2117 DOI: 10.1016/j.spinee.2013.12.026. (PMID: 24456678)
- 34 Lang S, Rupp M, Hanses F. et al. Infektionen der Wirbelsäule: Pyogene Spondylodiszitis und implantatassoziierte vertebrale Osteomyelitis. Unfallchirurg 2021; 124: 489-504 DOI: 10.1007/s00113-021-01002-w. (PMID: 33970304)
- 35 Han JS, Kim SH, Jin SW. et al. The use of gentamicin-impregnated collagen sponge for reducing surgical site infection after spine surgery. Korean J Spine 2016; 13: 129-133 DOI: 10.14245/kjs.2016.13.3.129. (PMID: 27799992)
- 36 Fleege C, Rauschmann M, Arabmotlagh M. et al. Development and current use of local antibiotic carriers in spondylodiscitis. Orthopäde 2020; 49: 714-723 DOI: 10.1007/s00132-020-03942-4. (PMID: 32719918)
- 37 Rickert M, Rauschmann M, Latif-Richter N. et al. Management of deep spinal wound infections following instrumentation surgery with subfascial negative pressure wound therapy. Neurosurg Clin N Am 2021; DOI: 10.1055/s-0040-1720999.
- 38 Urquhart DM, Zheng Y, Cheng AC. et al. Could low grade bacterial infection contribute to low back pain? a systematic review. BMC Med 2015; 13: 13 DOI: 10.1186/s12916-015-0267-x. (PMID: 25609421)
- 39 Lazary A, Klemencsics I, Szoverfi Z. et al. Global treatment outcome after surgical site infection in elective degenerative lumbar spinal operations. Surg Infect 2021; 22: 193-199 DOI: 10.1089/sur.2019.344. (PMID: 32326845)
- 40 Fessler RG, O’Toole JE, Eichholz KM. et al. The development of minimally invasive spine surgery. Neurosurg Clin N Am 2006; 17: 401-409 DOI: 10.1155/2014/293582. (PMID: 24967347)
- 41 LaGreca J, Hotchkiss M, Carry P. et al. Bacteriology and risk factors for development of late (greater than one year) deep infection following spinal fusion with instrumentation. Spine Deform 2014; 2: 186-190 DOI: 10.1016/j.jspd.2013.12.004. (PMID: 27927416)