Skip to main content
SpringerLink
Log in

Microbiologic profile of infections in presumed aseptic revision spine surgery

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

Intra-operative cultures may be obtained in revision spine surgery despite the absence of pre-operative clinical markers of infection. The microbiologic profile of culture positive cases in which there is no clear evidence of infection preoperatively has not been described. The aim of this investigation is to report on the microbiologic profile of unexpected culture positive revision spine surgery cases.

Methods

We retrospectively reviewed 595 consecutive revision spine surgeries performed between 2008 and 2013. Five hundred and seventy-eight revision surgeries were performed for diagnoses other than infection and were included in the study.

Results

Operative cultures were obtained in 112 cases (19.4 %). Cultures were positive in 45 cases. Pseudarthrosis was not only the most common diagnosis overall (49.1 %) in which intra-operative cultures were obtained, it was also the most common revision surgical diagnosis where cultures were positive (55.6 %). Propionibacterium acnes was cultured in 54.2 % of cases with the primary diagnosis of pseudarthrosis, but only in 40.9 % of cases with other diagnoses (P = 0.554). Overall, staphylococcal species were found most commonly (57.8 % of cases), but P. acnes was at least one of the isolates in 48.9 % of cases and was three times more common than any other organism.

Conclusions

Nearly one in five patients with the diagnosis of pseudarthrosis were culture positive. More specifically, pseudarthrosis was the most common culture positive diagnosis and P. acnes species predominated in this patient population. Propionibacterium acnes was overwhelmingly the most common single organism cultured in revision spine surgery. Given this, we recommend all cultures be held for P. acnes, particularly in the setting of pseudarthrosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Chaichana KL, Bydon M, Santiago-Dieppa DR et al (2014) Risk of infection following posterior instrumented lumbar fusion for degenerative spine disease in 817 consecutive cases. J Neurosurg Spine 20(1):45–52 (Epub 2013/11/12. PMID: 4206038)

    Article  PubMed  Google Scholar 

  2. Abdul-Jabbar A, Berven SH, Hu SS et al (2013) Surgical site infections in spine surgery: identification of microbiologic and surgical characteristics in 239 cases. Spine 38:E1425–E1431 (PMID: 23873240)

    Article  PubMed  Google Scholar 

  3. Kasliwal MK, Tan LA, Traynelis VC (2013) Infection with spinal instrumentation: review of pathogenesis, diagnosis, prevention, and management. Surg Neurol Int 4(Suppl 5):S392–S403 (Epub 2013/12/18. PMID: 24340238)

    PubMed  PubMed Central  Google Scholar 

  4. Updegrove GF, Armstrong AD, Kim HM (2015) Preoperative and intraoperative infection workup in apparently aseptic revision shoulder arthroplasty. J Shoulder Elbow Surg 24(3):491–500

    Article  PubMed  Google Scholar 

  5. Berend KR, Lombardi AV Jr, Adams JB (2007) Unexpected positive intraoperative cultures and gram stain in revision total hip arthroplasty for presumed aseptic failure. Orthopedics 30(12):1051–1053 (Epub 2008/01/18. PMID: 18198778)

    PubMed  Google Scholar 

  6. Foruria AM, Fox TJ, Sperling JW et al (2013) Clinical meaning of unexpected positive cultures (UPC) in revision shoulder arthroplasty. J Shoulder Elbow Surg 22(5):620–627 (PMID: 22981448)

    Article  PubMed  Google Scholar 

  7. Kim SJ, Kim JH (2014) Unexpected positive cultures including isolation of propionibacterium acnes in revision shoulder arthroplasty. Chin Med J (Engl) 127(22):3975–3979 (PMID: 25421200)

    Google Scholar 

  8. Kowalski TJ, Berbari EF, Huddleston PM et al (2007) The management and outcome of spinal implant infections: contemporary retrospective cohort study. Clin Infect Dis 44:913–920 (PMID: 17342641)

    Article  PubMed  Google Scholar 

  9. Rao SB, Vasquez G, Harrop J et al (2011) Risk factors for surgical site infections following spinal fusion procedures: a case-control study. Clin Infect Dis 53:686–692 (PMID: 21890772)

    Article  PubMed  Google Scholar 

  10. Hahn F, Zbinden R, Min K (2005) Late implant infections caused by propionibacterium acnes in scoliosis surgery. Eur Spine J 14(8):783–788 (PMID: 1581406)

    Article  PubMed  PubMed Central  Google Scholar 

  11. Ho C, Skaggs DL, Weiss JM et al (2007) Management of infection after instrumented posterior spine fusion in pediatric scoliosis. Spine 32(24):2739–2744 (PMID: 18007254)

    Article  PubMed  Google Scholar 

  12. Richards BR, Emara KM (2001) Delayed infections after posterior TSRH spinal instrumentation for idiopathic scoliosis: revisited. Spine 26(18):1990–1996 (PMID: 11547197)

    Article  CAS  PubMed  Google Scholar 

  13. Viola RW, King HA, Adler SM et al (1997) Delayed infection after elective spinal instrumentation and fusion. A retrospective analysis of eight cases. Spine 22(20):2444–2451 (PMID: 9355228)

    Article  CAS  PubMed  Google Scholar 

  14. Ince A, Seemann K, Frommelt L et al (2005) One-stage exchange shoulder arthroplasty for peri-prosthetic infection. J Bone Joint Surg Br 87(6):814–818 (PMID: 15911665)

    Article  CAS  PubMed  Google Scholar 

  15. McGoldrick E, McElvany MD, Butler-Wu S et al (2015) Substantial cultures of Propionibacterium can be found in apparently aseptic shoulders revised 3 years or more after the index arthroplasty. J Shoulder Elbow Surg 24(1):31–35 (PMID: 25022444)

    Article  PubMed  Google Scholar 

  16. Portillo ME, Corvec S, Borens O, et al (2013) Propionibacterium acnes: an underestimated pathogen in implant-associated infections. Biomed Res Int 804391. (Epub 2013 Nov 6. PMID: 24308006)

  17. Richards BS (1995) Delayed infections following posterior spinal instrumentation for the treatment of idiopathic scoliosis. J Bone Joint Surg Am 77(4):524–529 (PMID: 7713968)

    Article  CAS  PubMed  Google Scholar 

  18. Rihn JA, Lee JY, Ward WT (2008) Infection after the surgical treatment of adolescent idiopathic scoliosis: evaluation of the diagnosis, treatment, and impact on clinical outcomes. Spine 33(3):289–294 (PMID: 18303461)

    Article  PubMed  Google Scholar 

  19. Agarwal VJ, Golish SR, Alamin TF (2011) Bacteriologic culture of excised intervertebral disc from immunocompetent patients undergoing single level primary lumbar microdiscectomy. J Spinal Disord Tech 24:397–400 (PMID: 21150662)

    Article  PubMed  Google Scholar 

  20. Albert HB, Lambert P, Rollason J et al (2013) Does nuclear tissue infected with bacteria following disc herniations lead to Modic changes in the adjacent vertebrae? Eur Spine J 22(4):690–696 (PMID: 23397187)

    Article  PubMed  PubMed Central  Google Scholar 

  21. Andt J, Charles YP, Koebel C et al (2012) Bacteriology of degenerated lumbar intervertebral discs. J Spinal Disord Tech 25(7):E211–E216 (PMID:22832554)

    Article  Google Scholar 

  22. Corsia MF, Wack M, Denys G (2003) Low virulence bacterial infections of intervertebral discs and the resultant spinal disease processes. Abstract from Scoliosis Research Society (SRS) annual meeting

  23. Fritzell P, Bergström T, Welinder-Olsson C (2004) Detection of bacterial DNA in painful degenerated spinal discs in patients without signs of clinical infection. Eur Spine J 13:702–706 (PMID: 15138861)

    Article  PubMed  PubMed Central  Google Scholar 

  24. Stirling A, Worthington T, Rafiq M et al (2001) Association between sciatica and Propionibacterium acnes. Lancet 357:2024–2025 (PMID: 11438138)

    Article  CAS  PubMed  Google Scholar 

  25. Stirling AJ, Jiggins M (2002) Association between sciatica and skin commensals. International Society for the Study of the Lumbar Spine, Cleveland

    Google Scholar 

  26. Bémer P, Corvec S, Tariel et al (2008) Significance of Propionibacterium acnes-positive samples in spinal instrumentation. Spine 33(26):971–976 (PMID: 19092607)

    Article  Google Scholar 

  27. Bose B (2003) Delayed infection after instrumented spine surgery: case reports and review of the literature. Spine 3(5):394–399 (PMID: 14588952)

    Article  Google Scholar 

  28. Chaudhary SB, Vives MJ, Basra SK et al (2007) Postoperative spinal wound infections and postprocedural diskitis. J of Spinal Cord Med 30(5):441–451 (PMID: 18092559)

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hospital for Special Surgery, Spine Care Institute, 535 East 70th Street, New York, NY, 10021, USA

    Grant D. Shifflett, Benjamin T. Bjerke-Kroll, Benedict U. Nwachukwu, Janina Kueper, Jayme Burket, Andrew A. Sama, Federico P. Girardi, Frank P. Cammisa & Alexander P. Hughes

  2. 310 East 71st Street, Apt 3D, New York, NY, 10021, USA

    Grant D. Shifflett

Authors
  1. Grant D. Shifflett
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Benjamin T. Bjerke-Kroll
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Benedict U. Nwachukwu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Janina Kueper
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jayme Burket
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Andrew A. Sama
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Federico P. Girardi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Frank P. Cammisa
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Alexander P. Hughes
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Grant D. Shifflett.

Ethics declarations

Conflicts of interest

The authors declare that they have no conflict of interest.

Funding

No funding was required for completion of this study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shifflett, G.D., Bjerke-Kroll, B.T., Nwachukwu, B.U. et al. Microbiologic profile of infections in presumed aseptic revision spine surgery. Eur Spine J 25, 3902–3907 (2016). https://doi.org/10.1007/s00586-016-4539-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-016-4539-8

Keywords

Search

Navigation