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A high prevalence of Cutibacterium acnes infections in scoliosis revision surgery, a diagnostic and therapeutic dilemma

PURPOSE: To investigate if serum inflammatory markers or nuclear imaging can accurately diagnose a chronic spinal instrumentation infection (SII) prior to surgery. METHODS: All patients who underwent revision of spinal instrumentation after a scoliosis correction between 2017 and 2019, were retrospe...

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Autores principales: Gelderman, Stefan J., Faber, Christhoper, Kampinga, Greetje A., Jutte, Paul C., Ploegmakers, Joris J. W., Glaudemans, Andor W. J. M., Wouthuyzen-Bakker, Marjan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9970938/
https://www.ncbi.nlm.nih.gov/pubmed/36282416
http://dx.doi.org/10.1007/s43390-022-00599-1
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author Gelderman, Stefan J.
Faber, Christhoper
Kampinga, Greetje A.
Jutte, Paul C.
Ploegmakers, Joris J. W.
Glaudemans, Andor W. J. M.
Wouthuyzen-Bakker, Marjan
author_facet Gelderman, Stefan J.
Faber, Christhoper
Kampinga, Greetje A.
Jutte, Paul C.
Ploegmakers, Joris J. W.
Glaudemans, Andor W. J. M.
Wouthuyzen-Bakker, Marjan
author_sort Gelderman, Stefan J.
collection PubMed
description PURPOSE: To investigate if serum inflammatory markers or nuclear imaging can accurately diagnose a chronic spinal instrumentation infection (SII) prior to surgery. METHODS: All patients who underwent revision of spinal instrumentation after a scoliosis correction between 2017 and 2019, were retrospectively evaluated. The diagnostic accuracy of serum C-reactive protein (CRP) and Erythrocyte Sedimentation Rate (ESR), (18)F-fluorodeoxyglucose positron emission tomography combined with computed tomography (FDG–PET/CT) and Technetium-99m-methylene diphosphonate (99mTc-MDP) 3-phase bone scintigraphy (TPBS) to diagnose infection were studied. Patients with an acute infection or inadequate culture sampling were excluded. SII was diagnosed if ≥ 2 of the same microorganism(s) were isolated from intra-operative tissue cultures. RESULTS: 30 patients were included. The indication for revision surgery was pseudoarthrosis in the majority of patients (n = 15). 22 patients (73%) were diagnosed with SII. In all infected cases, Cutibacterium acnes was isolated, including 5 cases with a polymicrobial infection. The majority of patients had low inflammatory parameters preoperatively. For CRP > 10.0 mg/L, the sensitivity was 9.1% and specificity 100%; for ESR > 30 mm/h, the sensitivity was 9.1% and specificity 100%. The diagnostic accuracy for nuclear imaging was 64% for the FDG–PET/CT and 67% for the TPBS to diagnose infection. CONCLUSIONS: The prevalence of SII in patients undergoing revision spinal surgery is high, with Cutibacterium acnes as the main pathogen. No diagnostic tests could be identified that could accurately diagnose or exclude SII prior to surgery. Future studies should aim to find more sensitive diagnostic modalities to detect low-grade inflammation.
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spelling pubmed-99709382023-03-01 A high prevalence of Cutibacterium acnes infections in scoliosis revision surgery, a diagnostic and therapeutic dilemma Gelderman, Stefan J. Faber, Christhoper Kampinga, Greetje A. Jutte, Paul C. Ploegmakers, Joris J. W. Glaudemans, Andor W. J. M. Wouthuyzen-Bakker, Marjan Spine Deform Case Series PURPOSE: To investigate if serum inflammatory markers or nuclear imaging can accurately diagnose a chronic spinal instrumentation infection (SII) prior to surgery. METHODS: All patients who underwent revision of spinal instrumentation after a scoliosis correction between 2017 and 2019, were retrospectively evaluated. The diagnostic accuracy of serum C-reactive protein (CRP) and Erythrocyte Sedimentation Rate (ESR), (18)F-fluorodeoxyglucose positron emission tomography combined with computed tomography (FDG–PET/CT) and Technetium-99m-methylene diphosphonate (99mTc-MDP) 3-phase bone scintigraphy (TPBS) to diagnose infection were studied. Patients with an acute infection or inadequate culture sampling were excluded. SII was diagnosed if ≥ 2 of the same microorganism(s) were isolated from intra-operative tissue cultures. RESULTS: 30 patients were included. The indication for revision surgery was pseudoarthrosis in the majority of patients (n = 15). 22 patients (73%) were diagnosed with SII. In all infected cases, Cutibacterium acnes was isolated, including 5 cases with a polymicrobial infection. The majority of patients had low inflammatory parameters preoperatively. For CRP > 10.0 mg/L, the sensitivity was 9.1% and specificity 100%; for ESR > 30 mm/h, the sensitivity was 9.1% and specificity 100%. The diagnostic accuracy for nuclear imaging was 64% for the FDG–PET/CT and 67% for the TPBS to diagnose infection. CONCLUSIONS: The prevalence of SII in patients undergoing revision spinal surgery is high, with Cutibacterium acnes as the main pathogen. No diagnostic tests could be identified that could accurately diagnose or exclude SII prior to surgery. Future studies should aim to find more sensitive diagnostic modalities to detect low-grade inflammation. Springer International Publishing 2022-10-25 2023 /pmc/articles/PMC9970938/ /pubmed/36282416 http://dx.doi.org/10.1007/s43390-022-00599-1 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Case Series
Gelderman, Stefan J.
Faber, Christhoper
Kampinga, Greetje A.
Jutte, Paul C.
Ploegmakers, Joris J. W.
Glaudemans, Andor W. J. M.
Wouthuyzen-Bakker, Marjan
A high prevalence of Cutibacterium acnes infections in scoliosis revision surgery, a diagnostic and therapeutic dilemma
title A high prevalence of Cutibacterium acnes infections in scoliosis revision surgery, a diagnostic and therapeutic dilemma
title_full A high prevalence of Cutibacterium acnes infections in scoliosis revision surgery, a diagnostic and therapeutic dilemma
title_fullStr A high prevalence of Cutibacterium acnes infections in scoliosis revision surgery, a diagnostic and therapeutic dilemma
title_full_unstemmed A high prevalence of Cutibacterium acnes infections in scoliosis revision surgery, a diagnostic and therapeutic dilemma
title_short A high prevalence of Cutibacterium acnes infections in scoliosis revision surgery, a diagnostic and therapeutic dilemma
title_sort high prevalence of cutibacterium acnes infections in scoliosis revision surgery, a diagnostic and therapeutic dilemma
topic Case Series
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9970938/
https://www.ncbi.nlm.nih.gov/pubmed/36282416
http://dx.doi.org/10.1007/s43390-022-00599-1
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