Staphylococcus aureus Surgical Site Infections After Unilateral Biportal Endoscopic Spine Surgery
Overview
This report presents two cases of Staphylococcus aureus surgical site infections (SSIs) following unilateral biportal endoscopic (UBE) spine surgery. Key risk factors identified include inadequate preoperative skin preparation, intraoperative fluid leakage, prolonged operative time, and suboptimal postoperative wound care.
Background
Surgical site infection remains a significant complication after spinal surgery, with incidence rates varying widely depending on surgical technique and patient factors. Unilateral biportal endoscopic (UBE) spine surgery is a minimally invasive approach that reduces tissue trauma but is not immune to infectious complications. Staphylococcus aureus, including methicillin-resistant strains, is a leading cause of SSIs in orthopedic and spinal procedures. Understanding the unique risk factors and microbiological profiles associated with UBE surgery is essential to improve prevention strategies.
Both patients developed deep SSIs caused by Staphylococcus aureus confirmed by culture after UBE spine surgery.
Inadequate preoperative skin preparation and absence of prophylactic antibiotics were common factors.
Intraoperative fluid leakage leading to soaked surgical drapes was observed in both cases, facilitating bacterial contamination.
Prolonged operative time and compromised postoperative wound care contributed to infection risk, particularly in the second case.
Antibiotic susceptibility profiles differed, suggesting infections originated from patients’ own colonizing flora.
Implementation of nurse-led skin cleansing, increased draping layers, and physician-only postoperative dressing changes eliminated new SSIs over a subsequent year.
Clinical Implications
These cases highlight the importance of comprehensive perioperative protocols to prevent SSIs in UBE spine surgery. Strict preoperative skin preparation, prevention of intraoperative fluid leakage, minimizing operative time, and ensuring sterile postoperative wound care are critical. Institutional measures such as nurse-led skin cleansing and exclusive physician postoperative dressing changes can effectively reduce infection risk.
Conclusion
Surgical site infections after UBE spine surgery are multifactorial and can be effectively mitigated through targeted interventions addressing preoperative, intraoperative, and postoperative factors. Adoption of these strategies led to a sustained reduction in SSIs in subsequent clinical practice.
References
Meta-analysis of SSI incidence in spinal surgery (1)
Prospective cohort study identifying SSI risk factors (2)
Reports on SSIs following UBE procedures (3,4)
Role of Staphylococcus aureus in orthopedic SSIs (5)
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