Continuous local antibiotics perfusion (CLAP) for deep surgical site infection of Cutibaterium Acne after spinal instrumentation surgery — The International Society for the Study of the Lumbar Spine
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  3. Continuous local antibiotics perfusion (CLAP) for deep surgical site infection of Cutibaterium Acne after spinal instrumentation surgery

Continuous local antibiotics perfusion (CLAP) for deep surgical site infection of Cutibaterium Acne after spinal instrumentation surgery (#1077)

Kengo Fujii 1 , Junichiro Morita 1 , Takushi Nakatani 1 , Kaishi Ogawa 1 , Takumi Ichihara 1 , Sayaka Tanabe 1 , Keigo Nagasawa 1 , Toshimi Oda 2 , Itsuo Shiina 3 , Kousei Miura 4 , Hisanori Gamada 4 , Fumihiko Eto 4 , Sayori Li 1 , Masashi Yamazaki 4
  1. Showa General Hospital, Kodaira, TOKYO, Japan
  2. Infectious Diseases, Showa General Hospital, Tokyo, Japan
  3. Orthopaedic Surgery, Sogo Moriya Daiichi Hospital, Moriya, Ibaraki, Japan
  4. Department of orthopaedic surgery, Faculty of medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan

INTRODUCTION

Cutibacterium acne (C. Acne) is known as a gram-positive anaerobic resident skin bacteria. It is also known as a pathogen of surgical site infection(SSI). Biofilm formation by C. Acne generally leads to intractable infections, and it has been reported that preservation of instruments is usually difficult. We report two cases of C.Acne infection after spinal instrumentation treated with continuous local antibiotics perfusion (CLAP). In one case, spinal instrumentation was preserved.

CASE PRESENTATION

Case 1: 84-year-old male, who underwent C7-T3 posterior fixation was diagnosed as deep SSI, 4 months after primary surgery. C. Acne was detected as a pathogen, and CLAP was installed after surgical irrigation and debridement and implant removal. CLAP was used for 14 days. Wound dehiscence occurred 6 days after CLAP removal, CLAP was reinstalled after second surgical irrigation and debridement .Patient discharged after 14 days of CLAP and 6 weeks of intravenous vancomycin administration. There is no recurrence after 1 year.

Case2: 68-year-old male, who underwent C2-T3 posterior decompression fusion for myelopathy due to cervical ossification of longitudinal ligament had fever and swelling of the wound 4 weeks after surgery. He was diagnosed as having deep SSI and CLAP was installed after surgical irrigation and debridement. C.Acne was detected from samples obtained during debridement. CLAP was used for 10 days, and 6 weeks of  intravenous Teicoplanin (TEIC) and Ceftriaxone (CTRX) were administered. There is no recurrence after 10 months.

DISCUSSION

CLAP has been introduced recently and has been used for intratable SSI, mainly trauma cases in orthopaedics. Local administration/perfusion of high concentration Gentamicin (GM) is considered effective to eradicate biofilms around implants. CLAP enables continuous appropriate local antibiotic concentration without systemic side effects of antibiotics by continuously draining them by negative pressure wound therapy (NPWT) system. Previous studies have shown difficulties in C. Acne infection after surgery with implants, especially in preserving implants due to its biofilm formation. In our cases, C. Acne infections were successfully controlled by CLAP, and implants were preserved in one case.



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