ABSTRACT
INTRODUCTION: Spinal epidural abscess (SEA) is a rare process with significant risk for morbidity and mortality. Treatment includes an extended course of antibiotics with or without surgery depending on the clinical presentation. Both non-operative and surgically treated patients require close follow-up to ensure the resolution of the infection without recurrence and/or progression of neurologic deficits. No previous study has looked specifically at follow-up in the SEA population, but the review of the literature does show evidence of varying degrees of difficulty with follow-up for this patient population. METHODS: This retrospective review looked at follow-up for 147 patients with SEA at a single institution from 2012 to 2021. Statistical analyses were performed to assess differences between groups of surgical versus non-surgical patients and those with adequate versus inadequate follow-up. RESULTS: Sixty-two of 147 (42.2%) patients had inadequate follow-up (less than 90 days) with their surgical team, and 112 of 147 (76.2%) patients had inadequate follow-up (less than 90 days) with infectious disease (ID). The primary statistically significant difference between patients with adequate versus inadequate follow-up was found to be surgical status with those treated surgically more likely to have adequate follow-up than those treated non-operatively. CONCLUSION: Improved follow-up in surgical patients should be considered as a factor when deciding on surgical versus non-operative treatment in the SEA patient population. Extra efforts coordinating follow-up care should be made for SEA patients.
ABSTRACT
BACKGROUND: Guidance for wound management of the vacated generator pocket in cardiac implantable electronic device (CIED) pocket infections after removal of all hardware and tissue debridement is limited. The typical surgical technique for management of a purulent wound is to allow healing by secondary intention. An alternative approach uses negative pressure wound therapy with or without delayed primary closure. While effective in managing infection, these approaches increase hospital length of stay and costs. We present our experience with a third option: modified early primary wound closure over a suction device. METHODS: All patients with CIED pocket infections who presented to our institution between September 2018 and October 2020 underwent extraction of hardware and modified primary wound closure over a negative pressure Jackson-Pratt drain. Length of hospital and postoperative stay, complications, and recurrent infections were recorded. RESULTS: During the study period, 14 patients underwent modified primary wound closure for CIED pocket infections. Mean length of hospital stay was 6.64 days ± 4.01 days (standard deviation [SD]). Mean postoperative length of stay was 3.92 ± 2.21 days (SD). Two patients (both on intravenous heparin for mechanical valve prostheses) required re-exploration for bleeding. No patients developed recurrent infection at a mean follow up of 363 ± 245 days (SD). CONCLUSION: Based on our experience, early modified primary wound closure for CIED pocket infections appears to be safe and allows for prompt discharge with no observed re-infections.
