Volume 2 | Issue 1 | April-September 2021 | page: 19-22 | Bharat R. Dave, Ajay Krishnan, Ravi Ranjan Rai, Devanand Degulmadi, Shivanand Mayi, Kirit Jadhav
Authors: Bharat R. Dave , Ajay Krishnan , Ravi Ranjan Rai ,
Devanand Degulmadi , Shivanand Mayi , Kirit Jadhav 
 Department of Spine Surgery, Stavya Spine Hospital and Research Institute, Ahmedabad, Gujarat, India.
Address of Correspondence
Dr. Ravi Ranjan Rai,
Consultant Spine Surgeon, Stavya Spine Hospital and Research Institute, Ahmedabad, Gujarat, India.
Background: Systematic cultures of drain tips or drainage fluids are commonly used by surgical teams for the early detection of Surgical Site Infection (SSI), even in the absence of clinical suspicion of infection. However, their prognostic values are controversial.
Method: This was a prospective study of patients undergoing spine surgery at our institute during the study period. Patients already diagnosed with spine infection were excluded from the study. At the time of drain removal, the drain tip was cut and sent to microbiology laboratory for bacterial culture. All patients were treated with antimicrobial prophylaxis based on evidence-based guidelines and were monitored for at least 6 months after surgery for the development of Surgical Site Infection (SSI). SSI was defined according to Centers for Disease Control and Prevention criteria.
Results: The study comprised of 183 patients including 85 males and 98 females. The rate of Surgical Site Infection in our study was 2.73 % (5 patients). Drain Tip Culture (DTC) was positive in 4 patients (2.18 %). Association of DTC with SSI was found to have high Specificity (98.31 %) and Negative Predictive Value (97.76 %) but low Sensitivity (20 %) and Positive Predictive Value (25 %).
Conclusion: Culture of drain tip after spine surgery does not conclusively predict the presence or absence of surgical site infection. However, statistical significance was observed between drain tip culture and surgical site infection with high specificity, high negative predictive value, low sensitivity and low positive predictive value.
Keywords: Drain tip culture; Spinal Surgery; Surgical site infection.
. Chahoud J, Kanafani Z, Kanj SS. Surgical site infections following spine surgery: eliminating the controversies in the diagnosis. Front Med (Lausanne) 2014; 1:7.
. Gaynes RP, Culver DH, Horan TC, et al. Surgical site infection (SSI) rates in the United States, 1992–1998: the NationalNosocomial Infections Surveillance System basic SSI risk index. Clin Infect Dis 2001;33 (suppl 2): S69–77.
. O’Toole JE, Eichholz KM, Fessler RG. Surgical site infection rates after minimally invasive spinal surgery. J Neurosurg Spine 2009; 11:471–6.
. Smith JS, Shaffrey CI, Sansur CA, et al. Rates of infection after spine surgery based on 108,419 procedures: a report from the Scoliosis Research Society Morbidity and Mortality Committee. Spine (Phila Pa 1976) 2011; 36:556–63.
. Olsen MA, Mayfield J, Lauryssen C, et al. Risk factors for surgical site infection in spinal surgery. J Neurosurg 2003;98: 149–55.
. Weinstein MA, McCabe JP, Cammisa FP. Postoperative spinal wound infection: a review of 2,391 consecutive index procedures. J Spinal Disord 2000; 13:422–6.
. Reiffel AJ, Barie PS, Spector JA. A Multi-Disciplinary Review of the Potential Association between Closed-Suction Drains and Surgical Site Infection. Surg Infect 2013; 14:244-269. https://doi.org/10.1089/sur.2011.126.
. Barbadoro P, Marmorale C, Recanatini C, Mazzarini G, Pellegrini I, D’Errico MM, et al. May the drain be a way in for microbes in surgical infections? Am J Infect Control 2016 Mar 1; 44:283-288. https://doi.org/10.1016/j.ajic.2015.10.012.
. Tschudin-Sutter S, Meinke R, Schuhmacher H, Dangel M, Eckstein F, Reuthebuch O, et al. Drainage days-an independent risk factor for serious sternal wound infections after cardiac surgery: a case control study. Am J Infect Control 2013; 41:1264-1267. https://doi.org/10.1016/j.ajic.2013.03.311.
. Ahn J-S, Lee H-J, Park E, Park I-Y, Lee JW. Suction Drain Tip Culture after Spine Surgery: Can It Predict a Surgical Site Infection? Asian Spine J 2015; 9:863-868. https://doi.org/10.4184/asj.2015.9.6.863.
. Lindgren U, Elmros T, Holm SE. Bacteria in hip surgery. A study of routine aerobic and anaerobic cultivation from skin and closed suction wound drains. Acta Orthop Scand. 1976; 47:320–323.
. Sørensen AI, Sørensen TS. Bacterial growth on suction drain tips. Prospective study of 489 clean orthopedic operations. Acta Orthop Scand. 1991; 62:451–454.
. Petsatodis G, Parziali M, Christodoulou AG, et al. Prognostic value of suction drain tip culture in determining joint infection in primary and non-infected revision total hip arthroplasty: a prospective comparative study and review of the literature. Arch Orthop Trauma Surg. 2009; 129:1645–1649.
. Weinrauch P. Diagnostic value of routine drain tip culture in primary joint arthroplasty. ANZ J Surg. 2005; 75:887–888.
. Bernard L, Pron B, Vuagnat A, et al. Groupe d’Etude sur l’Oste´ ite. The value of suction drainage fluid culture during aseptic and septic orthopedic surgery: a prospective study of 901 patients. Clin Infect Dis. 2002; 34:46–49.
. Overgaard S, Thomsen NO, Kulinski B, et al. Closed suction drainage after hip arthroplasty. Prospective study of bacterial contamination in 81 cases. Acta Orthop Scand. 1993; 64:417–420.
. Girvent R, Marti D, Mun˜ oz JM. The clinical significance of suction drainage cultures. Acta Orthop Belg. 1994; 60:290–292.
. Sankar B, Ray P, Rai J. Suction drain tip culture in orthopaedic surgery: a prospective study of 214 clean operations. Int Orthop. 2004; 28:311–314.
. Nakayama Y, Tsuji T, Asazuma T, et al. Evaluation of the usefulness of bacterial culture of drainage tube tip in spinal instrumentation surgery. Natl Defense Med J. 2005; 52:79–82.
. Nagashima H, Yamane K, Nishi T, et al. Recent trends in spinal infections: retrospective analysis of patients treated during the past 50 years. Int Orthop. 2010; 34:395–399.
. Chen AF, Chivukula S, Jacobs LJ, et al. What is the prevalence of MRSA colonization in elective spine cases? Clin Orthop Relat Res. 2012; 470:2684–2689.
 Humphreys H. Staphylococcus aureus: the enduring pathogen in surgery. Surgeon. 2012; 10:357–360.
 Li Zhang, Siyu Cao, Nicole Marsh, Gillian Ray-Barruel, Julie Flynn, Emily Larsen, and Claire M Rickard. Infection risks associated with peripheral vascular catheters. J Infect Prev. 2016 Sep; 17(5): 207–213. doi: 10.1177/1757177416655472
 Lindsay E Nicolle. Catheter associated urinary tract infections. Antimicrob Resist Infect Control. 2014; 3: 23. Published online 2014 Jul 25. doi: 10.1186/2047-2994-3-23
|How to Cite this Article: Dave BR, Krishnan A, Rai RR, Degulmadi D, Mayi S, Jadhav K | Drain Tip Culture: Would It Help Us Predict and Prevent Surgical Site Infection After Spinal Surgery? | Back Bone: The Spine
Journal | April-September 2021; 2(1): 19-22.