How would you manage and determine the duration of antibiotics for a patient with suspected chronic postoperative spinal implant infection, status post lumbar fusion, now presenting with loosened hardware on imaging, normal inflammatory markers, and no systemic infection symptoms?

Loosening can be identified as lucency around pedicle screws on standard radiography, commonly at the upper or lower ends of the surgical construct. It was graded on a scale of 0-3. High-grade loosening (grade 2 or 3) is associated with increased odds of requiring revision surgery. It can be mechani...

Follow-up: The patient is 8 weeks status post (s/p) revision of non-union. The decision post-op was to withhold antibiotics pending cultures. All intra-operative cultures for bacteria, fungi, and mycobacteria have been finalized with no growth. The patient is clinically improved and increasingly mob...

PET scan, molecular-based. Microbial detection (eg., WGS, etc). If negative or equivocal, repeat all in 4-6 months.