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2
D.G. NAUMOV et AL., 2023
microbiological spectrum of ssi pathogens in patients with chronic infectious spondylitis
requiring revision surgery: results of continuous monocentric 5-year monitoring
D.G. Naumov1,2, A.A. Vishnevskij, N.S. Solovieva1, N.Y. Masalova1, P.K. Yablonsky1'2, A.A. Karpushin1
1St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg, Russia 2St. Petersburg State University, St. Petersburg, Russia
Objective. To analyze the results of the continuous monocentric 5-year microbiological monitoring of causative agents of surgical site infection (SSI) in patients who underwent primary surgery for chronic infectious spondylitis and required revision surgery. Material and Methods. The study included patient data from 2018 to 2022. The primary cohort included 569 consecutively operated patients with chronic infectious spondylitis of nonspecific (nj = 214) and tuberculous (n2 = 355) etiology. The analyzed sample was formed taking into according to inclusion and exclusion criteria. Thus, in 99 patients who required revision surgical interventions due to the development of SSI, a continuous microbiological monitoring of pathogens was performed, including the assessment of drug resistance and the timing of the development of infectious complications. Periodization of the time of SSI development was performed according to the accepted classification of Prinz et al. (2020), the assessment of drug resistance spectrum was performed according to the EUCAST recommendations (2020) and taking into account the approved methodological recommendations.
Results. In the general structure of surgical interventions for chronic infectious spondylitis, the share of revision interventions due to the development of SSI was 17.4 %. The highest incidence of complications was noted in the late postoperative period (x2 = 9.237; p = 0.009). Bacterial detection from the material of vertebral localization was noted in 43 cases (48.3 %), pathogen strains were isolated in urine in 28 (60.8 %), in decubital ulcers in 11 (23.9 %) and in hemoculture in 7 (15.2 %) patients. Culture negative SSI was detected in 10 cases (10.1 %) in the late period. Infectious complications in the setting of chronic non-specific spondylitis were detected more frequently than in spondylitis of tuberculous etiology (x2 = 21.345; p < 0.001). Gram-positive multidrug-resistant and Gram-negative bacteria with extreme resistance prevailed in the microbiological landscape of late SSI, and Gram-positive strains without drug resistance in that of early and delayed SSI (x2 = 17.516; p = 0.0032).
Conclusion. Drug-resistant Gram-positive bacteria predominate in the structure of SSI with a significantly higher frequency of complication development. Nonspecific etiology of spondylitis is associated with a significantly higher incidence of SSI. In the absence of a positive result of bacteriological examination of the material of vertebral localization, it is advisable to collect blood, decubital ulcer secretion and urine sampling.
Key Words: surgical site infection, SSI, spondylitis, complications, microbiological monitoring.
Please cite this paper as: Naumov DG, Vishnevskiy AA, Solovieva NS, Masalova NY, Yablonsky PK, Karpushin AA. Microbiological spectrum of SSI pathogens in patients with chronic infectious spondylitis requiring revision surgery: results of continuous monocentric 5-year monitoring. Russian Journal of Spine Surgery (Khirurgiya Pozvonochnika). 2023;20(4):68—74. In Russian. DOI: http://dx.doi.org/10.14531/ss2023A.68-74.
Chronic infectious spondylitis comprises an etiologically heterogeneous group of aggressive lesions united by the predominant destruction of the anterior spinal column [1-3].
The standard for the treatment of acute forms (the duration of the disease is no more than 30 days) of infectious spondylitis includes isolated
etiotropic antimicrobial therapy for types A1-B2, according to Pola et al. (2017), or debridement of the infectious process site in combination with extrafocal instrumentation and long-term etiotropic antimicrobial therapy [4]. When spondylitis becames chronic (meaning that the therapeutic pause lasts for three months or longer), not only
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debridement of the suppurative focus is required, but also a three-column reconstruction with sagittal balance parameter correction as a key criterion for guaranteeing the patient's quality of life during the postoperative period [5]. The performance of such surgeries is associated with high risks of developing a deep surgical site infection (SSI) both in
d.g. naumov et al. microbiological spectrum of ssi pathogens in patients with chronic infectious spondylitis
the early (first 30 days after the surgery) and in the long-term period [6-9]. The progression of the infectious process more often results in the formation of two pathological conditions: segmental instability with the development of pseudoarthrosis and secondary spinal stenosis with neurological conditions [10-12]. Among the main challenges solved during revision surgeries, it is essential to highlight the relief of signs of local and systemic inflammatory response syndrome, the restoration of spinal stability, and the decompression of intracanal neural structures [13-15].
One of the causes for SSI is the high resistance of microbial strains to antimicrobial drugs, which, according to various authors, ranges from 1.1 to 7.4 % [16, 17]. Despite the optimization of the schemes of preoperative systemic antimicrobial therapy and the improvement of methods for the prevention of SSI (intra-wound use of vancomycin and irrigation of the surgical area with iodine-containing antiseptic solutions), the incidence of infectious complications after reconstructive surgeries in conditions of chronic infectious spondylitis reaches 21-29 % [18-20].
Monitoring of the microbiological spectrum of SSI pathogens is a major asset to both the prevention of infectious complications of primary reconstructions in chronic spondylitis and the treatment of SSI in patients who require revision surgeries. The lack of specialized articles and the accumulated experience of the institution provide a way to systematize the data on the issue under consideration.
The objective is to analyze the results of the continuous monocentric 5-year microbiological monitoring of causative agents of surgical site infection (SSI) in patients who underwent primary surgery for chronic infectious spondylitis and required revision surgeries.
Answers to the following questions are required:
1) Are there differences in the micro-bial landscape depending on the timing of SSI development?
2) What is the structure of drug resistance of pathogens depending on the time of SSI development?
Design: continuous multicenter cohort study corresponding to Class III, according to Burns et al. (2011).
Material and Methods
The study was performed from January 1, 2018 to December 31, 2022.
The inclusion of patients in the study was performed considering the following criteria:
• chronic spondylitis etiologically verified by histological or bacteriological technique at the time of primary reconstructive surgery;
• the presence of SSI requiring revision surgery;
• patient's age 18 years and more at the time of revision surgery;
• verification of wound cavity discharge with determination of the spectrum of drug sensitivity of the SSI pathogen;
• verification of the pathogen from hemoculture (triplicate blood sampling at the height of fever), urine, subclavian catheters, and superficial discharge of decubitus ulcers in culture-negative SSI, combined with the presence of clinical manifestations;
• follow-up for a period of 6 months or more.
Exclusion criteria: no indications for revision surgery.
During the analyzed period, 569 patients with chronic infectious spondylitis were sequentially operated on: primary reconstructions were performed in 364 (63.9 %) cases, and revision surgeries were performed in 205 (36.1 %) cases (primary surgeries were performed outside the institution). The final cohort consisted of 99 patients who suffered SSI at different times of the postoperative period, requiring repeated surgery. The study flow diagram is shown in Fig.
The following parameters are distinguished in the structure of the analyzed parameters: 1) a variant of the SSI pathogen; 2) the spectrum of drug resistance of SSI pathogens; 3) the period of development of SSI according to the peri-odization according to Prinz et al. (early:
<6 weeks; delayed: >6 weeks; late: >12 months) [21].
The sampling of organic matter for bacteriological examination was performed before the revision surgery from the wound exudate (in the presence of a fistula) and directly during the intervention (granulation tissue, pus). In cases of delayed and late SSI and instability of the posterior instrumentation, the removing of supporting elements was attended by ultrasound treatment of the implant surface, followed by bacteriological examination.
The detection of non-specific microflora and Mycobacterium spp. was performed via inoculation onto a solid and liquid medium. DNA detection of the Mycobacterium tuberculosis-complex and amplification of the nucleo-tide sequence of IS6110, a marker of the Mycobacterium tuberculosis complex, were performed using the test system of DNA-Technology Scientific production association (Russia) by real-time PCR (RT-PCR) on an iCyclerQ analyzer from Bio-Rad (USA).
The threshold value of the colony-forming unit (CFU) of SSI pathogens for inclusion in the study was taken to be >105 (a lower CFU value was considered a variant of contamination of the sample).
Bacteriological examination of biomaterial for anaerobic and facultative anaerobic organisms in all cases was supplemented by the detection of drug susceptibility of SSI pathogens by the disk diffusion test according to the guidelines of EUCAST (2020) and in accordance with the standards and guidelines of procedural guidelines MUK 4.2.1890-04 "Determination of antimicrobial drug susceptibility of organisms", approved by the Public Health Officer of the Russian Federation on March 4, 2004. The verification for low-pathogenic microflora was not performed due to a lack of technical capacity.
In accordance with the recommendations of the Clinical and Laboratory Standards Institute (CLSI), the European Committee on Antimicrobial Susceptibility Testing (EUCAST) and the USA Food and Drug Administration
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(FDA), the microorganisms with multidrug resistance (resistance to one antimicrobial drug in three or more groups of drugs), extensively drug resistance (resistance to one or more antimicrobial drug in all groups, with the exception of 1-2 categories) and pandrug resistance (resistance to all antimicrobial drugs in all groups) were isolated in the structure of drug susceptibility [22].
A histopathological examination was performed on the basis of studying the specimen of vertebral localization obtained by needle core biopsy.
The statistical analysis was performed in accordance with the recommendations of the International Association for Osteosynthesis [23]. We used the Statistical Package for the Social Sciences (SPSS) software, version 22.0 (SPSS Inc., Chicago, IL, USA). The test of the studied parameters for the normality of the distribution was performed according to the Kolmogorov-Smirnov test. The bilateral significance value for all quantitative parameters was p < 0.05, that suggests their abnormal distribution. The Krus-kal-Wallis H-test was used to evaluate the significance of the differences in the timing of SSI development. The effect of the spondylitis etiology on the spectrum of drug susceptibility was tested according to Pearson's chi-squared test with the construction of contingency tables. The differences were considered statistically significant if the bilateral p 0.05.
Results
According to the periodization of the SSI development by Prinz and Vajkoc-zy [21], the highest rate of complications was noted in the late postoperative period: 54 (54.5%) cases; there were fewer cases in the early (31 patients) and delayed (14 patients) periods (2 = 9.237; p = 0.009).
The SSI pathogens were verified in 89 (89.8 %) patients, while the detection of microorganisms from the vertebral localization specimen was noted in 43 (48.3 %) cases. In cases of culture-negative SSI combined with clinical manifestations (fistula in the surgical
site, increased CRP > 10 mg/l, and ESR > 30 mm/h) and histologic signs of inflammation, strains of pathogens were isolated in urine in 28 (60.8 %), in decubital ulcers in 11 (23.9 %) and in hemoculture in 7 (15.2 %) patients.
In 10 (10.1 %) patients with clinical signs of SSI, histologic signs of inflammation and a negative result of bacteriological examination of the specimen of both vertebral and other localization, the diagnosis of "SSI with an unidentified pathogen" was established. Meanwhile, the infection was detected in the late postoperative period in all cases.
The etiology of chronic spondylitis had a considerable effect on the incidence rate of SSI: postoperative complications associated with chronic nonspecific spondylitis were observed in 67 (67.6 %) cases and in 32 (32.3 %) in tuberculous cases; x2 = 21.345; p < 0.001.
Significant differences have been revealed in the structure of the microbial landscape. For example, multidrug-resis-tant gram-positive and gram-negative
bacteria with extensively drug resistance were more often isolated in patients with late SSI, while the pathogens of early and delayed SSI were more often gram-positive bacteria without drug resistance (X2 = 17.516; p = 0.0032). Verification of two microorganisms was noted in 32 observations, three in 6 observations.
The distribution of selected isolates of vertebral localization, depending on the timing of SSI development, is given in the Table.
During the evaluation of drug resistance of pathogens obtained from vertebral localization, the proportion of gram-positive multidrug-resistant strains was 30.3 %, 63.0 % of which accounted for Staph. Epidermi-dis (MRSE) and 37.0 % for Staph. Aureus (MRSA). In the structure of gramnegative bacteria, the proportion of resistant strains reached 80.0 %: 87.5 % of the isolates had extensively drug resistance (Klebsiella spp. and Acineto-bacter spp.) and 12.5 % had pandrug resistance (Pseud. Aureginosa).
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Table Microbiological landscape depending on the timing of development of surgical site infection (SSI), n (%)
Strains Total Early SSI Delayed SSI Late SSI
Gramm-positive 33 (76.7) 8 (18.6) 4 (9.3) 11 (25.5)
Including multidrug-resistant 10 (30.3) 1 (2.3) 1 (2.3) 8 (18.6)
Gramm-negative 10 (23.2) 2 (20.0) 1 (10.0) -
Including extensively drug-resistant 6 (60.0) 1 (10.0) 1 (10.0) 4 (40.0)
Pandrug-resistant 1 (10.0) - - 1 (10.0)
* statistically significant differences were detected between the late and early/delayed SSI groups (X2 = 17,516; p = 0,0032). according to the Kruskal - Wallis H test
Discussion
Revision surgeries for spondylitis are one of the most difficult issues in spine surgery since they are associated with a large number of infectious complications and high economic expenditures for providing secondary care [24, 25]. Despite the increased number of publications in the considered field, data on the long-term outcomes of revision surgery in patients with chronic infectious spondylitis is limited, and data reflecting the results of microbiological monitoring in this cohort are given in single articles [1, 4, 6, 9].
The prediction of SSI development in spine surgery remains relevant, although there is no consensus. Among the risk factors, there are patient-associated (Charlson index, BMI, concomitant rheumatological pathology and others) and surgery-associated (primary or revision surgery, duration of surgery and blood loss volume, surgery level, and others) [18, 19, 24]. Mueller et al. [7] proposed a risk scale for the development of SSI after spine surgery, in which the revision nature of the intervention is considered one of the most significant predictors of infectious complications [7].
The study of long-term outcomes in patients operated on for nonspecific spondylodiscitis shows a significant dependence between the type of pathogen and mortality. According to
Kehrer et al. [25], mortality in the early and delayed postoperative periods is higher in patients with multidrug-resistant strains of Staph. aureus, while multidrug-resistant gram-negative microorganisms were more often detected in the late period. Similar outcomes were found in our cohort: there was one lethal outcome of a patient with late deep SSI associated with gramnegative extensively drug-resistant bacteria.
One of the ways to prevent SSI during initially pathogen-free spine surgery is the intrawound administration of vancomycin. A meta-analysis by Shan et al. [26] indicates a significant effect of this technique on the risk of infectious complications. Attention should also be paid to the nature of microorganisms in the presented cohort associated with SSI in the early postoperative period: grampositive bacteria were detected in 75 % of cases, which provides a recommendation for the intrawound administration of vancomycin in this category of patients.
Gram-positive microorganisms were the main strains in the general cohort of SSI pathogens: 76.7 % versus 23.2 %, with Staphylococcus spp. on the leading position. Representatives of Enterococ-cus spp., mainly E. faecalis and E. fae-cium, were detected in the structure of the hospital-acquired flora, while the pathogen was detected in urine and decubital ulcers secretion. A feature of this group of microorganisms was
multidrug resistance to third- and fourth-generation fluoroquinolones. Similar trends were detected during 6-year monitoring of the structure and resistance of the leading pathogens at the Russian Scientific Research Institute of Traumatology and Orthopedics, named after R.R. Vreden [27].
Conclusion
Microbiological monitoring in patients with chronic infectious spondylitis has identified the following: gram-positive drug-resistant bacteria predominate in the structure of SSI pathogens; the development of late SSI is statistically significant due to multidrug-resistant gram-positive and extensively drug-resistant gram-negative microorganisms; the nonspecific etiology of spondylitis is associated with a considerably higher incidence rate of SSI; if there is no positive outcome of bacteriological examination of the vertebral localization specimen, it is advisable to take blood, discharge from decubital ulcers and urine.
The study had no sponsors. The authors declare that they have no conflict of interest. The study was approved by the local ethics committees of the institutions. All authors contributed significantly to the research and preparation of the article, read and approved the final version before publication.
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References
1. Lora-Tamayo J, Euba G, Narvaez JA, Murillo O, Verdaguer R, Sobrino B, Nar-vaez J, Nolla JM, Ariza J. Changing trends in the epidemiology of pyogenic vertebral osteomyelitis: the impact of cases with no microbiologic diagnosis. Semin Arthritis Rheum. 2011;41:247-255. DOI: 10.1016/j.semarthrit.2011.04.002.
2. Stricsek G, Iorio J, Mosley Y, Prasad S, Heller J, Jallo J, Shahrokh S, Harrop JS. Etiology and surgical management of cervical spinal epidural abscess (SEA): a systematic review. Global Spine J. 2018;8(4 Suppl):59S-67S. DOI: 10.1177/2192568218772048.
3. Yoon SH, Chung SK, Kim KJ, Kim HJ, Jin YJ, Kim HB. Pyogenic vertebral osteomyelitis: identification of microorganism and laboratory markers used to predict clinical outcome. Eur Spine J. 2010;19:575-582. DOI: 10.1007/s00586-009-1216-1.
4. Mushkin AYu, Vishnevsky AA. Clinical recommendations for the diagnosis of infectious spondylitis. Project for discussion. Medictsinskij Aljans. 2018;(3):65-74.
5. Bazarov AYu, Naumov DG, Mushkin AYu, Sergeyev KS, Ryabykh SO, Vishnevsky AA, Burtsev AV, Mushkin MA. A new classification of spondylodiscitis: possibility of validation and multidisciplinary expert consensus. Russian Journal of Spine Surgery (Khirurgiya Pozvonochnika). 2022;19(4):68-76. DOI: 10.14531/ss2022.4.68-76.
6. D'Agostino C, Scorzolini L, Massetti AP, Carnevalini M, d'Ettorre G, Vendit-ti M, Vullo V, Orsi GB. A seven-year prospective study on spondylodiscitis: epidemiological and microbiological features. Infection. 2010;38:102-107. DOI: 10.1007/ s15010-009-9340-8.
7. Mueller KB, Hou Y, Beach K, Griffin LP. Development and validation of a point-of-care clinical risk score to predict surgical site infection following open spinal fusion. N Am Spine Soc J. 2022;13:100196. DOI: 10.1016/j.xnsj.2022.100196.
8. Naumov DG, Tkach SG, Mushkin AYu, Makogonova ME. Chronic infectious lesions of the cervical spine in adults: monocentric cohort analysis and literature review. Russian Journal of Spine Surgery (Khirurgiya Pozvonochnika). 2021;18(3): 68-76. DOI: 10.14531/ss2021.3.68-76.
9. Kang SJ, Jang HC, Jung SI, Choe PG, Park WB, Kim CJ, Song KH, Kim ES, Kim HB, Oh MD, Kim NJ, Park KH. Clinical characteristics and risk factors of pyogenic spondylitis caused by Gram-negative bacteria. PLoS One 2015;10:e0127126. DOI: 10.1371/journal.pone.0127126.
10. Tsiskarashvili AV, Gorbatyuk DS, Melikova RE, Pkhakadze TY, Kazmin AI, Suleimanov MA. Microbiological spectrum of causative agents of implant-associated infection in the treatment of complications of transpedicular fixation of the spine using the negative pressure method. Russian Journal of Spine Surgery (Khirurgiya Pozvonoch-nika). 2022;19(3):77-87. DOI: 10.14531/ss2022.3.77-87.
11. Wang X, Lin Y, Yao W, Zhang A, Gao L, Feng F. Surgical site infection in spinal surgery: a bibliometric analysis. J Orthop Surg Res. 2023;18:337. DOI: 10.1186/ s13018-023-03813-6.
12. Hu X, Lieberman IH. Revision spine surgery in patients without clinical signs of infection: How often are there occult infections in removed hardware? Eur Spine J. 2018;27:2491-2495. DOI: 10.1007/s00586-018-5654-5.
13. Shirai T, Tsuchiya H, Terauchi R, Tsuchida S, Shimomura S, Kajino Y, Taka-hashi K. Iodine-supported implants in prevention and treatment of surgical site infections for compromised hosts: a prospective study. J Orthop Surg Res. 2023;18:388. DOI: 10.1186/s13018-023-03868-5.
14. Yagi M, Fujita N, Hasegawa T, Inoue G, Kotani Y, Ohtori S, Orita S, Oshima Y, Sakai D, Sakai T, Taneichi H, Togawa D, Nakanishi K, Nakashima H, Yoshii T, Nakamura M, Iwasaki M, Watanabe M, Haro H, Kanemura T, Hosogane N.
Nationwide survey of the surgical complications associated with lateral lumbar inter-body fusion in 2015-2020. Spine Surg Relat Res. 2022;7:249-256. DOI: 10.22603/ ssrr.2022-0194.
15. Mengis-Palleck CL, Tome-Bermejo F, Pinera-Parrilla A, Cervera-Irimia J, Gallego-Bustos J, Garzon-Marquez F, Rodriguez-Arguisjuela MG, Sanz-Aguilera S,
Peiro-Garcia A, Alvarez-Galovich L. Surgical site infection after polymethyl meth-acrylate pedicle screw augmentation in osteoporotic spinal vertebrae: a series of 537 cases. Int J Spine Surg. 2023;17:587-597. DOI: 10.14444/8474.
16. Zhou J, Wang R, Huo X, Xiong W, Kang L, Xue Y. Incidence of surgical site infection after spine surgery: a systematic review and meta-analysis. Spine. 2020;45:208-216. DOI: 10.1097/BRS.0000000000003218.
17. Prinz V, Bayerl S, Renz N, Trampuz A, Czabanka M, Woitzik J, Vajkoczy P, Finger T. High frequency of low-virulent microorganisms detected by sonication of pedicle screws: a potential cause for implant failure. J Neurosurg Spine. 2019;31: 424-429. DOI: 10.3171/2019.1.SPINE181025.
18. Abdallah DY, Jadaan MM, McCabe JP. Body mass index and risk of surgical site infection following spine surgery: a meta-analysis. Eur Spine J. 2013;22:2800-2809. DOI: 10.1007/s00586-013-2890-6.
19. Anderson PA, Savage JW, Vaccaro AR, Radcliff K, Arnold PM, Lawrence BD, Shamji MF. Prevention of surgical site infection in spine surgery. Neurosurgery. 2017;80(3S):S114-S123. DOI: 10.1093/neuros/nyw066.
20. Agarwal A, Lin B, Wang JC, Schultz C, Garfin SR, Goel VK, Anand N, Agarw-al AK. Efficacy of intraoperative implant prophylaxis in reducing intraoperative microbial contamination. Global Spine J. 2019;9:62-66. DOI: 10.1177/2192568218780676.
21. Prinz V, Vajkoczy P. Surgical revision strategies for postoperative spinal implant infections (PSII). J Spine Surg. 2020;6:777-784. DOI: 10.21037/jss-20-514.
22. Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, Harbarth S, Hindler JF, Kahlmeter G, Olsson-Liljequist B, Paterson DL, Rice LB, Stelling J, Struelens MJ, Vatopoulos A, Weber JT, Monnet DL. Multidrug-resis-tant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012;18:268-281. DOI: 10.1111/j.1469-0691.2011.03570.x.
23. Falavigna A, Jimenez Avila JM. Education in Research: from the Idea to the Publication. Caxias do Sul, RS: EDUCS, 2015.
24. Blumberg TJ, Woelber E, Bellabarba C, Bransford R, Spina N. Predictors of increased cost and length of stay in the treatment of postoperative spine surgical site infection. Spine J. 2018;18:300-306. DOI: 10.1016/j.spinee.2017.07.173.
25. Kehrer M, Pedersen C, Jensen TG, Hallas J, Lassen AT. Increased short- and long-term mortality among patients with infectious spondylodiscitis compared with a reference population. Spine J. 2015;15:1233-1240. DOI: 10.1016/j.spinee.2015.02.021.
26. Shan S, Tu L, Gu W, Aikenmu K, Zhao J. A meta-analysis of the local application of vancomycin powder to prevent surgical site infection after spinal surgeries. J Int Med Res. 2020;48:300060520920057. DOI: 10.1177/0300060520920057.
27. Bozhkova SA, Kasimova AR, Tikhilov RM, Polyakova EM, Rukina AN, Shabano-va VV, Liventsov VN. Adverse trends in the etiology of orthopedic infection: results of 6-year monitoring of the structure and resistance of leading pathogens. Travma-tologiya I ortopediya Rossii (Traumatology and Orthopedics of Russia. 2018;24(4):20-31. DOI: 10.21823/2311-2905-2018-24-4-20-31.
Address correspondence to:
Naumov Denis Georgyevich
St. Petersburg Research Institute of Phthisiopulmonology, 2-4 Ligovsky Ave, St. Petersburg, 191036, Russia, dg.naumov@spbniif.ru
Received 02.09.2023
Review completed23.11.2023
Passed for printing 27.11.2023
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d.g. naumov et al. microbiological spectrum of ssi pathogens in patients with chronic infectious spondylitis
Denis Georgyevich Naumov, MD, PhD, leading researcher, Head of the Research Laboratory of Spine Pathology, Head of the Spine Surgery Department 6, St.Petersburg Research Institute of Phthisiopulmonology, 2-4 Ligovsky Ave, St. Petersburg, 191036, Russia; Assistant, Department of General Surgery, St. Petersburg State University, 7/9 UniversitetskayaEmbankment, St. Petersburg, 199034, Russia, ORCID: 0000-0002-9892-6260, dg.naumov@spbniif.ru;
Arkady Anatolyevich Vishnevskiy, DMSc, leading researcher of the Research Laboratory of Spine Pathology, neurosurgeon, Spine Surgery Department 6, St.Petersburg Research Institute of Phthisiopulmonology, 2-4 Ligovsky Ave, St. Petersburg, 191036, Russia, ORCID: 0000-0002-9186-6461, vichnevsky@mail.ru; Natalja Sergeyevna Solovieva, MD, PhD, Head of Bacteriological Laboratory, St. Petersburg Research Institute of Phthisiopulmonology, 2-4 Ligovsky Ave, St. Petersburg, 191036, Russia, ORCID: 0000-0003-1509-0734, ns.solovyeva@spbniif.ru;
Natalja Yuryevna Masalova, clinical pharmacologist, St. Petersburg Research Institute of Phthisiopulmonology, 2-4 Ligovsky Ave, St. Petersburg, 191036, Russia, ORCID: 0009-0004-7632-6450, ny.masalova@spbniif.ru;
Pyotr Kazimirovich Yablonsky, DMSc, Professor, Director St. Petersburg Research Institute of Phthisiopulmonology, 2-4 Ligovsky Ave, St. Petersburg, 191036, Russia; Vice-Rector for Medical Activities, St. Petersburg State University, 7/9 Universitetskaya Embankment, St. Petersburg, 199034, Russia, ORCID: 0000-0003-4385-9643, piotr_jablonskii@mail. ru;
Andrey Andreyevich Karpushin, intern researcher of the Research Laboratory of Spine Pathology, traumatologist-orthopedist, Spine Surgery Department 6, St. Petersburg Research Institute of Phthisiopulmonology, 2-4 Ligovsky Ave, St. Petersburg, 191036, Russia, ORCID: 0000-0002-7178-3861, karpushin.spine@yandex.ru.
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tumors and inflammatory diseases of the spine
