Antibiotic prophylaxis in spine surgery: a comparison of single-dose and 72-hour protocols

Despite the general consensus on the use of single-dose antimicrobial prophylaxis (AMP) in instrumented spine surgery, evidence supporting this approach is not robust. To compare the efficacies of single-dose and 72 h AMP protocols for the prevention of surgical site infection (SSI) in instrumented...

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Bibliographic Details
Published in:The Journal of hospital infection 2019-11, Vol.103 (3), p.303-310
Main Authors: Maciejczak, A., Wolan-Nieroda, A., Wałaszek, M., Kołpa, M., Wolak, Z.
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Antibiotic Prophylaxis - methods
Antimicrobial prophylaxis
Female
Humans
Incidence
Instrumented spine surgery
Laminectomy
Male
Middle Aged
Prospective Studies
Risk factors
Spinal fusion
Spine - surgery
Surgical site infection
Surgical Wound Infection - epidemiology
Surgical Wound Infection - prevention & control
Treatment Outcome
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Summary:Despite the general consensus on the use of single-dose antimicrobial prophylaxis (AMP) in instrumented spine surgery, evidence supporting this approach is not robust. To compare the efficacies of single-dose and 72 h AMP protocols for the prevention of surgical site infection (SSI) in instrumented spine surgery (ISS) in a before-and-after study. Prospective non-randomized cohort study on 5208 patients who underwent spine surgery in one neurosurgical department between 2003 and 2014. Two protocols of AMP were compared in ISS: a single-dose protocol from 2003 to 2008, and a 72 h protocol from 2009 to 2014. Patients undergoing non-instrumented spine surgery (NSS) received single-dose prophylaxis throughout both periods. The outcome measure was the incidence of SSI. For ISS, the SSI incidences were 5.3% for the single-dose protocol and 2.2% for the 72 h protocol (P < 0.01). For NSS, the SSI incidence was 0.8% between 2003 and 2008 and 1.2% between 2009 and 2014 (P = 0.054). Multiple correspondence analysis showed that in surgeries with an implant a one-dose prophylaxis carries a 7.1% risk of SSI; patients who received 72 h prophylaxis had a lower (3.6%) risk of SSI. Analysis of individual categories of data suggests that 72 h prophylaxis was the most important factor for minimizing the risk of wound infection in our study group.
ISSN:0195-6701
1532-2939
DOI:10.1016/j.jhin.2019.04.017