The Prevalence of Bacterial Infection in Patients Undergoing Elective ACDF for Degenerative Cervical Spine Conditions: A Prospective Cohort Study With Contaminant Control

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  • Bivona, Louis J.
    • Other Affiliation: Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
  • Camacho, Jael E.
    • Other Affiliation: Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
  • Usmani, Farooq
    • Other Affiliation: Department of General Surgery, Eastern Virginia Medical School, Norfolk, VA, USA
  • Nash, Alysa
    • Affiliation: School of Medicine, Department of Orthopaedics
  • Bruckner, Jacob J.
    • Other Affiliation: Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
  • Hughes, Meghan
    • Other Affiliation: Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
  • Bhandutia, Amit K.
    • Other Affiliation: Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
  • Koh, Eugene Y.
    • Other Affiliation: Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
  • Banagan, Kelley E.
    • Other Affiliation: Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
  • Gelb, Daniel E.
  • Ludwig, Steven C.
Abstract
  • Study Design: Prospective cohort study. Objectives: To determine the prevalence of bacterial infection, with the use of a contaminant control, in patients undergoing anterior cervical discectomy and fusion (ACDF). Methods: After institutional review board approval, patients undergoing elective ACDF were prospectively enrolled. Samples of the longus colli muscle and disc tissue were obtained. The tissue was then homogenized, gram stained, and cultured in both aerobic and anaerobic medium. Patients were classified into 4 groups depending on culture results. Demographic, preoperative, and postoperative factors were evaluated. Results: Ninety-six patients were enrolled, 41.7% were males with an average age of 54 ± 11 years and a body mass index of 29.7 ± 5.9 kg/m2. Seventeen patients (17.7%) were considered true positives, having a negative control and positive disc culture. Otherwise, no significant differences in culture positivity was found between groups of patients. However, our results show that patients were more likely to have both control and disc negative than being a true positive (odds ratio = 6.2, 95% confidence interval = 2.5-14.6). Propionibacterium acnes was the most commonly identified bacteria. Two patients with disc positive cultures returned to the operating room secondary to pseudarthrosis; however, age, body mass index, prior spine surgery or injection, postoperative infection, and reoperations were not associated with culture results. Conclusion: In our cohort, the prevalence of subclinical bacterial infection in patients undergoing ACDF was 17.7%. While our rates exclude patients with positive contaminant control, the possibility of contamination of disc cultures could not be entirely rejected. Overall, culture results did not have any influence on postoperative outcomes.
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  • Article
Rights statement
  • In Copyright
Rights holder
  • AO Spine, unless otherwise noted. Manuscript content on this site is licensed under Creative Commons Licenses
License
  • Attribution-NonCommercial-NoDerivatives 4.0 International
Journal title
  • Global Spine Journal
Journal volume
  • 11
Journal issue
  • 1
Page start
  • 13
Page end
  • 20
ISSN
  • 2192-5690
  • 2192-5682
Copyright date
  • 2019
Publisher
  • SAGE Publications

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