Staphylococcus aureus surgical site infection following unilateral biportal endoscopic spine surgery: a two-case report

Background: Surgical site infection (SSI) is a serious complication of spinal surgery, including minimally invasive unilateral biportal endoscopic (UBE) procedures. Staphylococcus aureus (S. aureus) is a leading cause of such infections. This report analyses two cases of S. aureus SSI following UBE surgery. Case presentation: Two patients (one male and one female) aged 56 underwent elective UBE surgery. Both patients had inadequate preoperative skin preparation. The cases were complicated by intraoperative fluid leakage, which led to soaked surgical drapes. The second case also involved prolonged operative time and failure of postoperative wound care, with the patient performing unsterile dressing changes at home. Both patients developed deep SSIs caused by S. aureus, as confirmed by culture. This required readmission, endoscopic debridement and targeted antibiotic therapy. Discussion: The differences in the antibiotic susceptibility profiles of the two cases suggest that the SSIs were likely caused by the patients' own colonising flora. Key risk factors identified include inadequate skin preparation, intraoperative fluid leakage, prolonged surgery and breaches in postoperative care. These factors likely facilitated bacterial ingress and infection. In response, the institution implemented three key measures: direct nurse-led preoperative skin cleansing; increased surgical draping layers to prevent fluid saturation; and exclusive physician-performed postoperative dressings. Following these interventions, no new SSI cases were observed for over a year. Conclusion: SSI after UBE surgery is multifactorial. A comprehensive strategy that addresses preoperative, intraoperative and postoperative protocols is crucial for prevention. The simple, targeted interventions described here effectively mitigated the risk of infection in our subsequent practice.