Postoperatif spinal cerrahi alan enfeksiyonlarında risk faktörleri, tanı ve tedavi yöntemleri: 36 vakanın retrospektif analizi

Abstract

Amaç: Postoperatif spinal cerrahi alan enfeksiyonları (CAE), hasta morbiditesini, sağlık maliyetlerini ve iyileşmeyi ciddi oranda etkiler. Bu çalışmada spinal CAE'nin risk faktörleri, tanısal göstergeleri ve tedavi yöntemlerinin retrospektif olarak değerlendirilmesi amaçlandı. Gereç ve yöntem: Ocak 2014 – Ocak 2018 tarihleri arasında spinal CAE gelişen 36 hasta retrospektif olarak incelendi. Hasta ve cerrahi kaynaklı risk faktörleri, klinik bulgular, laboratuvar değerleri, mikrobiyolojik kültürler, radyolojik görüntülemeler ve tedavi sonuçları analiz edildi. Bulgular: Toplam 2.596 spinal cerrahi vakasında 36 CAE (%1,39) görüldü. En sık hipertansiyon, diyabet, koroner arter hastalığı, immünosupresyon ve sigara kullanımı risk faktörü olarak belirlendi. Erken dönemde gelişen enfeksiyonlar (<30 gün; %72,2) çoğunlukla yara akıntısıyla, geç dönemde gelişen enfeksiyonlar (>30 gün; %27,8) ise inatçı ağrı ile seyir gösterdi. Tanıda C-reaktif protein (CRP) ve nötrofil/lenfosit oranı (NLR) tanısal değeri yüksek bir bulgu olarak saptandı. Kültür pozitifliği erken enfeksiyonlarda daha yüksekti; en sık izole edilen patojen Escherichia coli idi. Derin enfeksiyonlu hastalarda antibiyotik tedavisi ve hastanede kalış süreleri daha uzundu (p<0,05). Cerrahi debridman, irrigasyon, vakum yardımlı kapama ve hiperbarik oksijen terapisi gibi multidisipliner yaklaşımlar gerekliydi. Agresif tedaviye rağmen 5 hasta komplikasyonlara bağlı kaybedildi. Sonuç: Detaylı risk değerlendirmesi, NLR ve CRP ile erken tanı, kültüre dayalı antibiyoterapi ve bireyselleştirilmiş multidisipliner yaklaşımlar spinal CAE yönetiminde kritik önem taşımaktadır.

Keywords

• Spinal enstrümantasyon
• cerrahi alan enfeksiyonu
• omurga cerrahisi
• nötrofil-lenfosit oranı (NLR)

Risk factors, diagnosis, and management of postoperative spinal surgical site infections: a retrospective analysis of 36 cases

Abstract

Purpose: Postoperative spinal surgical site infections (SSIs) significantly impact patient morbidity, healthcare costs, and recovery. This study aimed to identify risk factors and diagnostic indicators and discuss the treatment modalities for spinal SSI through retrospective analysis. Materials and methods: Data from 36 patients with spinal SSI, operated between January 2014 and January 2018, were retrospectively evaluated. Patient-related and surgery-related risk factors, clinical presentations, laboratory findings, microbiological cultures, radiological imaging, and treatment outcomes were analysed. Results: Among 2,596 spinal surgeries, 36 SSIs (1.39%) occurred. Common risk factors included hypertension, diabetes, coronary artery disease, immunosuppression, and smoking. Early-onset infections (<30 days; 72.2%) presented primarily with wound discharge; late-onset infections (>30 days; 27.8%) were characterised by persistent pain. CRP and neutrophil-to-lymphocyte ratio (NLR) were found to be important diagnostic markers. Culture positivity was higher in early-onset infections; Escherichia coli was the predominant pathogen. Deep infections required longer antibiotic therapy and hospital stay (p<0.05). Multidisciplinary management—including surgical debridement, irrigation, vacuum-assisted closure, and hyperbaric oxygen therapy—was essential. Despite aggressive treatment, five patients succumbed to complications. Conclusion: Meticulous risk assessment, early diagnosis using NLR and CRP, culture-guided antibiotic therapy, and individualised multidisciplinary strategies remain crucial for managing spinal SSIs effectively.

Keywords

• Spinal instrumentation
• surgical site infection
• spine surgery
• neutrophil-to-lymphocyte ratio (NLR)

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