Clinical Scorecard: Staphylococcus aureus Infections at Surgical Sites After Unilateral Biportal Endoscopic Spine Surgery: A Report on Two Cases

At a Glance

Key Highlights

• Two cases of deep SSIs caused by S. aureus after UBE surgery were linked to inadequate skin preparation, intraoperative fluid leakage, prolonged operative time, and poor postoperative wound care.
• Antibiotic susceptibility profiles suggested infections originated from patients' own colonising flora.
• Implementation of nurse-led preoperative skin cleansing, increased surgical draping layers, and physician-exclusive postoperative dressing changes eliminated new SSI cases for over one year.

Guideline-Based Recommendations

Diagnosis

• Confirm SSI by clinical signs (redness, pain, purulent discharge) and culture of wound and blood samples for S. aureus identification.

Management

• Perform endoscopic irrigation and debridement for deep SSIs.
• Administer targeted antibiotic therapy based on susceptibility, e.g., vancomycin followed by linezolid if indicated.

Monitoring & Follow-up

• Monitor wound healing post-debridement for absence of exudate, pus, and signs of reinfection.
• Ensure adherence to postoperative wound care protocols.

Risks

• Inadequate preoperative skin preparation increases risk of bacterial contamination.
• Intraoperative fluid leakage leading to soaked drapes facilitates bacterial ingress.
• Prolonged operative time (>3 hours) is associated with higher SSI risk.
• Patient non-adherence to sterile postoperative wound care increases infection risk.

Patient & Prescribing Data

Patients undergoing UBE spine surgery, including those with immunocompromised states or comorbidities

Targeted antibiotic therapy (vancomycin, linezolid) following culture confirmation is effective; early surgical debridement is critical for infection control.

Clinical Best Practices

• Implement direct nurse-led preoperative skin cleansing protocols rather than verbal instructions alone.
• Use multiple layers of surgical draping to prevent fluid saturation during surgery.
• Restrict postoperative wound dressing changes to trained physicians to ensure sterile technique.
• Educate patients on the importance of professional postoperative wound care and adherence to follow-up.

References

• Meta-analysis on SSI incidence in spinal surgery
• Prospective cohort study on SSI risk factors in spinal surgery
• Reports on SSIs following UBE procedures
• Role of Staphylococcus aureus in orthopedic SSIs
• Risk factors for SSIs including operative time and comorbidities