Outbreak of Enterobacter kobei infections linked to a collagen-based adhesion barrier following lumbar disc surgery: an epidemiological and molecular study.

BACKGROUND

Postoperative infections following spinal surgery are typically caused by skin flora or hospital-acquired pathogens. This article reports a novel outbreak of Enterobacter kobei infections linked to a collagen-based adhesion barrier.

AIM: To identify the source of increased surgical site infections in lumbar disc herniation (LDH) procedures, and to describe the outbreak investigation and containment measures implemented.

METHODS

A multi-disciplinary outbreak team conducted epidemiological, environmental and microbiological investigations at a secondary care hospital in Turkey. Molecular typing using pulsed-field gel electrophoresis (PFGE) was employed to assess the clonal relationships of the isolates.

FINDINGS: Between 19th May and 9th June 2023, 10 of 12 patients who underwent LDH surgery developed surgical site infections. Environmental cultures tested negative. Enterobacter cloacae was isolated from wound, blood and collagen-based adhesion barrier samples. Isolates sent to the National Public Health Laboratory were identified as E. kobei. PFGE analysis revealed two distinct but clonally related groups. The outbreak was contained following a nationwide recall of the adhesion barrier.

CONCLUSION

This incident marks the first reported outbreak of E. kobei associated with a surgical adhesion barrier. This highlights the need for vigilant infection control and careful monitoring of non-sterilized surgical materials to prevent similar events in the future.