{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:05:50Z","timestamp":1760144750543,"version":"build-2065373602"},"reference-count":26,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2024,5,7]],"date-time":"2024-05-07T00:00:00Z","timestamp":1715040000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: A superinfection occurs when a new, secondary organism colonizes an existing infection. Spine infections are associated with high patient morbidity and sometimes require multiple irrigations and debridements (I&amp;Ds). When multiple I&amp;Ds are required, the risk of complications increases. The purpose of this study was to report our experience with spine superinfections and determine which patients are typically affected. Methods: A retrospective case series of spine superinfections and a retrospective case\u2013control analysis were conducted. Data were collected manually from electronic medical records. Spine I&amp;Ds were identified. Groups were created for patients who had multiple I&amp;Ds for (1) a recurrence of the same causative organism or (2) a superinfection with a novel organism. Preoperative demographic, clinical, and microbiologic data were compared between these two outcomes. A case series of superinfections with descriptive data was constructed. Lastly, two illustrative cases were provided in a narrative format. Results: A total of 92 patients were included in this analysis. Superinfections occurred after 6 out of the 92 (7%) initial I&amp;Ds and were responsible for 6 out of the 24 (25%) repeat I&amp;Ds. The preoperative erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) of the patients with a superinfection were significantly lower than those in the control group (p = 0.022 and p = 0.032). Otherwise, the observed differences in the preoperative variables were not statistically different. In the six cases of superinfection, the presence of high-risk comorbidities, a history of substance abuse, or a lack of social support were commonly observed. The superinfecting organisms included Candida, Pseudomonas, Serratia, Klebsiella, Enterobacter, and Staphylococcus species. Conclusions: Superinfections are a devastating complication requiring reoperation after initial spine I&amp;D. Awareness of the possibility of superinfection and common patient archetypes can be helpful for clinicians and care teams. Future work is needed to examine how to identify, help predict, and prevent spine superinfections.<\/jats:p>","DOI":"10.3390\/jcm13102739","type":"journal-article","created":{"date-parts":[[2024,5,7]],"date-time":"2024-05-07T09:03:38Z","timestamp":1715072618000},"page":"2739","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Superinfections of the Spine: A Single-Institution Experience"],"prefix":"10.3390","volume":"13","author":[{"given":"Anthony K.","family":"Chiu","sequence":"first","affiliation":[{"name":"Department of Orthopaedics, University of Maryland School of Medicine, 110 S. Paca Street, 6th Floor Suite 300, Baltimore, MD 21201, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bibhas","family":"Amatya","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, University of Maryland School of Medicine, 110 S. Paca Street, 6th Floor Suite 300, Baltimore, MD 21201, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7468-0158","authenticated-orcid":false,"given":"Idris","family":"Amin","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, University of Maryland School of Medicine, 110 S. Paca Street, 6th Floor Suite 300, Baltimore, MD 21201, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amit S.","family":"Ratanpal","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, University of Maryland School of Medicine, 110 S. Paca Street, 6th Floor Suite 300, Baltimore, MD 21201, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandra Baker","family":"Lutz","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, University of Maryland School of Medicine, 110 S. Paca Street, 6th Floor Suite 300, Baltimore, MD 21201, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian M.","family":"Shear","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, University of Maryland School of Medicine, 110 S. Paca Street, 6th Floor Suite 300, Baltimore, MD 21201, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ivan B.","family":"Ye","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, University of Maryland School of Medicine, 110 S. Paca Street, 6th Floor Suite 300, Baltimore, MD 21201, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robin","family":"Fencel","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, University of Maryland School of Medicine, 110 S. Paca Street, 6th Floor Suite 300, Baltimore, MD 21201, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Louis J.","family":"Bivona","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, University of Maryland School of Medicine, 110 S. Paca Street, 6th Floor Suite 300, Baltimore, MD 21201, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eugene Y.","family":"Koh","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, University of Maryland School of Medicine, 110 S. Paca Street, 6th Floor Suite 300, Baltimore, MD 21201, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7878-0241","authenticated-orcid":false,"given":"Julio J.","family":"Jauregui","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, University of Maryland School of Medicine, 110 S. Paca Street, 6th Floor Suite 300, Baltimore, MD 21201, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven C.","family":"Ludwig","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, University of Maryland School of Medicine, 110 S. Paca Street, 6th Floor Suite 300, Baltimore, MD 21201, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel L.","family":"Cavanaugh","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, University of Maryland School of Medicine, 110 S. Paca Street, 6th Floor Suite 300, Baltimore, MD 21201, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,5,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"37S","DOI":"10.1177\/2192568217745512","article-title":"Postoperative Spine Infection: Diagnosis and Management","volume":"8","author":"Dowdell","year":"2018","journal-title":"Glob. Spine J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1097\/00002517-200010000-00009","article-title":"Postoperative Spinal Wound Infection: A Review of 2391 Consecutive Index Procedures","volume":"13","author":"Weinstein","year":"2000","journal-title":"J. Spinal Disord."},{"key":"ref_3","first-page":"203","article-title":"Postoperative Spine Infections","volume":"12","author":"Bassewitz","year":"2000","journal-title":"Semin. Spine Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1080\/10790268.2007.11753476","article-title":"Postoperative Spinal Wound Infections and Postprocedural Diskitis","volume":"30","author":"Chaudhary","year":"2007","journal-title":"J. Spinal Cord Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"182","DOI":"10.5312\/wjo.v3.i11.182","article-title":"Management of Postoperative Spinal Infections","volume":"3","author":"Hegde","year":"2012","journal-title":"World J. Orthop."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s41479-021-00083-w","article-title":"The Role of Co-Infections and Secondary Infections in Patients with COVID-19","volume":"13","author":"Feldman","year":"2021","journal-title":"Pneumonia"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"ofz063","DOI":"10.1093\/ofid\/ofz063","article-title":"Human Immunodeficiency Virus (HIV) 2 Superinfection in a Patient Receiving Antiretroviral Therapy with Longstanding HIV-1 Viral Load Suppression","volume":"6","author":"Ceia","year":"2019","journal-title":"Open Forum Infect. Dis."},{"key":"ref_8","first-page":"e23129","article-title":"Drains in Spine Surgery for Degenerative Disc Diseases: A Literature Review to Determine Its Usage","volume":"14","author":"Reier","year":"2022","journal-title":"Cureus"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Ho, C.-Y., Wang, Y.-C., Chin, S.-C., and Chen, S.-L. (2022). Factors Creating a Need for Repeated Drainage of Deep Neck Infections. Diagnostics, 12.","DOI":"10.3390\/diagnostics12040940"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e229987","DOI":"10.1136\/bcr-2019-229987","article-title":"Importance of Screening in Physical Therapy: Vertebral Fracture of Thoracolumbar Junction in a Recreational Runner","volume":"12","author":"Maselli","year":"2019","journal-title":"BMJ Case Rep."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1190","DOI":"10.1080\/09638288.2020.1804626","article-title":"The Diagnostic Value of Red Flags in Thoracolumbar Pain: A Systematic Review","volume":"44","author":"Maselli","year":"2022","journal-title":"Disabil. Rehabil."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"703","DOI":"10.4103\/ajns.AJNS_233_16","article-title":"Management of Postoperative Discitis: A Review of 31 Patients","volume":"13","author":"Singh","year":"2018","journal-title":"Asian J. Neurosurg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1670","DOI":"10.1007\/s11999-009-0740-y","article-title":"Diabetes Associated with Increased Surgical Site Infections in Spinal Arthrodesis","volume":"467","author":"Chen","year":"2009","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2415","DOI":"10.2147\/TCRM.S185221","article-title":"The Effect of Diabetes on Perioperative Complications Following Spinal Surgery: A Meta-Analysis","volume":"14","author":"Luo","year":"2018","journal-title":"Ther. Clin. Risk. Manag."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1713","DOI":"10.1016\/j.jocn.2013.01.021","article-title":"Effects of Diabetes and Smoking on Lumbar Spinal Surgery Outcomes","volume":"20","author":"Appaduray","year":"2013","journal-title":"J. Clin. Neurosci."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1348203","DOI":"10.3389\/fmed.2024.1348203","article-title":"Spinal Infection Caused by Aspergillus Flavus in a Diabetic: A Case Report and Literature Review","volume":"11","author":"Li","year":"2024","journal-title":"Front. Med."},{"key":"ref_17","first-page":"65","article-title":"Surgery for Spinal Tuberculosis: A Multi-Center Experience of 582 Cases","volume":"1","author":"Alam","year":"2015","journal-title":"J. Spine Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1136\/bmj.39335.541782.AD","article-title":"Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies","volume":"335","author":"Altman","year":"2007","journal-title":"BMJ"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Darwich, A., Dally, F.-J., Abu Olba, K., Mohs, E., Gravius, S., Hetjens, S., Assaf, E., and Bdeir, M. (2021). Superinfection with Difficult-to-Treat Pathogens Significantly Reduces the Outcome of Periprosthetic Joint Infections. Antibiotics, 10.","DOI":"10.3390\/antibiotics10101145"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"S125","DOI":"10.1097\/BRS.0b013e3181d8342c","article-title":"The Influence of Perioperative Risk Factors and Therapeutic Interventions on Infection Rates After Spine Surgery: A Systematic Review","volume":"35","author":"Schuster","year":"2010","journal-title":"Spine"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e552","DOI":"10.1016\/j.wneu.2018.12.151","article-title":"Operative Management of Spinal Infection Among Intravenous Drug Abusers","volume":"124","author":"Reid","year":"2019","journal-title":"World Neurosurg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e20.00007","DOI":"10.5435\/JAAOSGlobal-D-20-00007","article-title":"Septic Arthritis in Immunosuppressed Patients: Do Laboratory Values Help?","volume":"4","author":"Bell","year":"2020","journal-title":"JAAOS Glob. Res. Rev."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.jor.2022.08.007","article-title":"Effects of Immunocompromised Status on Diagnostic Criteria in Septic Arthritis","volume":"34","author":"Costello","year":"2022","journal-title":"J. Orthop."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Mancuso, G., Midiri, A., Gerace, E., and Biondo, C. (2021). Bacterial Antibiotic Resistance: The Most Critical Pathogens. Pathogens, 10.","DOI":"10.3390\/pathogens10101310"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Santajit, S., and Indrawattana, N. (2016). Mechanisms of Antimicrobial Resistance in ESKAPE Pathogens. Biomed. Res. Int., 2016.","DOI":"10.1155\/2016\/2475067"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"785","DOI":"10.21037\/jss-20-456","article-title":"Antibiotic Treatment of Postoperative Spinal Implant Infections","volume":"6","author":"Palmowski","year":"2020","journal-title":"J. Spine Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/10\/2739\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:40:49Z","timestamp":1760107249000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/10\/2739"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,7]]},"references-count":26,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2024,5]]}},"alternative-id":["jcm13102739"],"URL":"https:\/\/doi.org\/10.3390\/jcm13102739","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2024,5,7]]}}}