Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
European Spine Journal
Published in: European Spine Journal 10/2016

01-10-2016 | Original Article

Antimicrobial prophylaxis to prevent surgical site infection in adolescent idiopathic scoliosis patients undergoing posterior spinal fusion: 2 doses versus antibiotics till drain removal

Authors: Vijay H. D. Kamath, Jason Pui Yin Cheung, Kin Cheung Mak, Yat Wa Wong, Wai Yuen Cheung, Keith Dip Kei Luk, Kenneth Man Chee Cheung

Published in: European Spine Journal | Issue 10/2016

Login to get access

Abstract

Purpose

There is much variation in the choice, timing and duration of antimicrobial prophylaxis for preventing surgical site infections (SSI) but no guideline exists for scoliosis surgery. The aim of study was to compare the efficacy of two antimicrobial prophylaxis (AMP) protocols with cephazolin in preventing SSI in adolescent idiopathic scoliosis (AIS).

Methods

A retrospective comparative analysis of two post-operative AMP protocols (two postoperative doses versus continued antibiotics till drain removal) was performed. Patient characteristics, pre-operative, intra- and post-operative risk factors for infection, drain use, generic drug name and number of doses administered were recorded from 226 patients with AIS who had undergone posterior spinal fusion. Details of superficial or deep SSI and wound healing aberrations, and serious adverse events were recorded. Analysis was performed to evaluate differences in the pre-, intra- and post-operative variables between the two groups.

Results

155 patients received 2 postoperative doses of AMP and 71 patients had antibiotics till drain removal. The average follow-up was 43 months. The overall rate of SSI was 1.7 % for the spine wound and 1.3 % for the iliac crest wound. 1.9 % of patients with 2 doses of AMP and 1.4 % of patients with antibiotics till drain removal had SSI. No adverse reactions attributable to cephazolin were observed.

Conclusions

This is the first study on the AMP protocol in scoliosis surgery for SSI prevention. Results suggest that two doses of AMP are as effective as continued antimicrobial use until drain removal. Cephazolin appears to be effective and safe for prophylaxis.
Literature
1.
Benson ER, Thomson JD, Smith BG, Banta JV (1998) Results and morbidity in a consecutive series of patients undergoing spinal fusion for neuromuscular scoliosis. Spine (Phila Pa 1976) 23:2308–2317 (discussion 18) CrossRef
2.
Calderone RR, Garland DE, Capen DA, Oster H (1996) Cost of medical care for postoperative spinal infections. Orthop Clin North Am 27:171–182PubMed
3.
Glazer PA, Hu SS (1996) Pediatric spinal infections. Orthop Clin North Am 27:111–123PubMed
4.
Milstone AM, Maragakis LL, Townsend T, Speck K, Sponseller P, Song X, Perl TM (2008) Timing of preoperative antibiotic prophylaxis: a modifiable risk factor for deep surgical site infections after pediatric spinal fusion. Pediatr Infect Dis J 27:704–708CrossRefPubMed
5.
Whitehouse JD, Friedman ND, Kirkland KB, Richardson WJ, Sexton DJ (2002) The impact of surgical-site infections following orthopedic surgery at a community hospital and a University Hospital: adverse quality of life, excess length of stay, and extra cost. Infect Control Hosp Epidemiol 23:183–189CrossRefPubMed
6.
Horwitz NH, Curtin JA (1975) Prophylactic antibiotics and wound infections following laminectomy for lumber disc herniation. J Neurosurg 43:727–731CrossRefPubMed
7.
Rohde V, Meyer B, Schaller C, Hassler WE (1998) Spondylodiscitis after lumbar discectomy. Incidence and a proposal for prophylaxis. Spine (Phila Pa 1976) 23:615–620CrossRef
8.
Carreon LY, Puno RM, Dimar JR 2nd, Glassman SD, Johnson JR (2003) Perioperative complications of posterior lumbar decompression and arthrodesis in older adults. J Bone Joint Surg Am 85-A:2089–2092PubMed
9.
Rechtine GR, Bono PL, Cahill D, Bolesta MJ, Chrin AM (2001) Postoperative wound infection after instrumentation of thoracic and lumbar fractures. J Orthop Trauma 15:566–569CrossRefPubMed
10.
Carreon LY, Puno RM, Lenke LG, Richards BS, Sucato DJ, Emans JB, Erickson MA (2007) Non-neurologic complications following surgery for adolescent idiopathic scoliosis. J Bone Joint Surg Am 89:2427–2432CrossRefPubMed
11.
Coe JD, Arlet V, Donaldson W, Berven S, Hanson DS, Mudiyam R, Perra JH, Shaffrey CI (2006) Complications in spinal fusion for adolescent idiopathic scoliosis in the new millennium. A report of the Scoliosis Research Society Morbidity and Mortality Committee. Spine (Phila Pa 1976) 31:345–349CrossRef
12.
Grosman R, Vlach O, Leznar M (2002) Infections in surgery of idiopathic scoliosis. Acta Chir Orthop Traumatol Cech 69:175–178PubMed
13.
14.
Ho C, Sucato DJ, Richards BS (2007) Risk factors for the development of delayed infections following posterior spinal fusion and instrumentation in adolescent idiopathic scoliosis patients. Spine (Phila Pa 1976) 32:2272–2277CrossRef
15.
Rihn JA, Lee JY, Ward WT (2008) Infection after the surgical treatment of adolescent idiopathic scoliosis: evaluation of the diagnosis, treatment, and impact on clinical outcomes. Spine (Phila Pa 1976) 33:289–294CrossRef
16.
Barker FG 2nd (2002) Efficacy of prophylactic antibiotic therapy in spinal surgery: a meta-analysis. Neurosurgery 51:391–400 (discussion -1) PubMed
17.
Rubinstein E, Findler G, Amit P, Shaked I (1994) Perioperative prophylactic cephazolin in spinal surgery. A double-blind placebo-controlled trial. J Bone Joint Surg Br 76:99–102PubMed
18.
Savitz MH, Malis LI, Savitz SI (2003) Efficacy of prophylactic antibiotic therapy in spinal surgery: a meta-analysis. Neurosurgery 53:243–244 (author reply 4–5) CrossRefPubMed
19.
Nohara Y, Taneichi H, Ueyama K, Kawahara N, Shiba K, Tokuhashi Y, Tani T, Nakahara S, Iida T (2004) Nationwide survey on complications of spine surgery in Japan. J Orthop Sci 9:424–433CrossRefPubMed
20.
Takahashi H, Wada A, Iida Y, Yokoyama Y, Katori S, Hasegawa K, Shintaro T, Suguro T (2009) Antimicrobial prophylaxis for spinal surgery. J Orthop Sci 14:40–44CrossRefPubMed
21.
Page CP, Bohnen JM, Fletcher JR, McManus AT, Solomkin JS, Wittmann DH (1993) Antimicrobial prophylaxis for surgical wounds. Guidelines for clinical care. Arch Surg 128:79–88CrossRefPubMed
22.
Petignat C, Francioli P, Harbarth S, Regli L, Porchet F, Reverdin A, Rilliet B, de Tribolet N, Pannatier A, Pittet D, Zanetti G (2008) Cefuroxime prophylaxis is effective in noninstrumented spine surgery: a double-blind, placebo-controlled study. Spine (Phila Pa 1976) 33:1919–1924CrossRef
23.
Rimoldi RL, Haye W (1996) The use of antibiotics for wound prophylaxis in spinal surgery. Orthop Clin North Am 27:47–52PubMed
24.
Sanderson PJ (1993) Antimicrobial prophylaxis in surgery: microbiological factors. J Antimicrob Chemother 31(Suppl B):1–9CrossRefPubMed
25.
Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR (1999) Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control 27:97–132 (quiz 3–4; discussion 96) CrossRefPubMed
26.
Kanayama M, Hashimoto T, Shigenobu K, Oha F, Togawa D (2007) Effective prevention of surgical site infection using a Centers for Disease Control and Prevention guideline-based antimicrobial prophylaxis in lumbar spine surgery. J Neurosurg Spine 6:327–329CrossRefPubMed
27.
Kernodle DS, Classen DC, Burke JP, Kaiser AB (1990) Failure of cephalosporins to prevent Staphylococcus aureus surgical wound infections. JAMA 263:961–966CrossRefPubMed
28.
Kakimaru H, Kono M, Matsusaki M, Iwata A, Uchio Y (2010) Postoperative antimicrobial prophylaxis following spinal decompression surgery: is it necessary? J Orthop Sci 15:305–309CrossRefPubMed
29.
Olsen MA, Nepple JJ, Riew KD, Lenke LG, Bridwell KH, Mayfield J, Fraser VJ (2008) Risk factors for surgical site infection following orthopaedic spinal operations. J Bone Joint Surg Am 90:62–69CrossRefPubMed
30.
Richards BS (1995) Delayed infections following posterior spinal instrumentation for the treatment of idiopathic scoliosis. J Bone Joint Surg Am 77:524–529PubMed
31.
Dobzyniak MA, Fischgrund JS, Hankins S, Herkowitz HN (2003) Single versus multiple dose antibiotic prophylaxis in lumbar disc surgery. Spine (Phila Pa 1976) 28:E453–E455CrossRef
32.
Dimick JB, Lipsett PA, Kostuik JP (2000) Spine update: antimicrobial prophylaxis in spine surgery: basic principles and recent advances. Spine (Phila Pa 1976) 25:2544–2548CrossRef
33.
Cahill PJ, Warnick DE, Lee MJ, Gaughan J, Vogel LE, Hammerberg KW, Sturm PF (2010) Infection after spinal fusion for pediatric spinal deformity: thirty years of experience at a single institution. Spine (Phila Pa 1976) 35:1211–1217CrossRef
34.
Savitz SI, Lee LV, Goldstein HB, Savitz MH (1994) Investigations of the bacteriologic factors in cervical disk surgery. Mt Sinai J Med 61:272–275PubMed
35.
Tronnier V, Schneider R, Kunz U, Albert F, Oldenkott P (1992) Postoperative spondylodiscitis: results of a prospective study about the aetiology of spondylodiscitis after operation for lumbar disc herniation. Acta Neurochir (Wien) 117:149–152CrossRef
36.
Weinstein MA, McCabe JP, Cammisa FP Jr (2000) Postoperative spinal wound infection: a review of 2,391 consecutive index procedures. J Spinal Disord 13:422–426CrossRefPubMed
37.
38.
DiPiro JT, Bowden TA Jr, Hooks VH 3rd (1984) Prophylactic parenteral cephalosporins in surgery. Are the newer agents better? JAMA 252:3277–3279CrossRefPubMed
39.
Oishi CS, Carrion WV, Hoaglund FT (1993) Use of parenteral prophylactic antibiotics in clean orthopaedic surgery. A review of the literature. Clin Orthop Relat Res 296:249–255 PubMed
40.
Hellbusch LC, Helzer-Julin M, Doran SE, Leibrock LG, Long DJ, Puccioni MJ, Thorell WE, Treves JS (2008) Single-dose vs multiple-dose antibiotic prophylaxis in instrumented lumbar fusion—a prospective study. Surg Neurol 70:622–627 (discussion 7) CrossRefPubMed
41.
Shaffer WO, Baisden J, Fernand R, Matz P (2013) Antibiotic Prophylaxis in Spine Surgery. NASS Clin Guidelines 33–36
Metadata
Title
Antimicrobial prophylaxis to prevent surgical site infection in adolescent idiopathic scoliosis patients undergoing posterior spinal fusion: 2 doses versus antibiotics till drain removal
Authors
Vijay H. D. Kamath
Jason Pui Yin Cheung
Kin Cheung Mak
Yat Wa Wong
Wai Yuen Cheung
Keith Dip Kei Luk
Kenneth Man Chee Cheung
Publication date
01-10-2016
Publisher
Springer Berlin Heidelberg
Published in
European Spine Journal / Issue 10/2016
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-016-4491-7

Other articles of this Issue 10/2016

European Spine Journal 10/2016 Go to the issue

Original Article

Single- versus dual-rod anterior instrumentation of thoracolumbar curves in adolescent idiopathic scoliosis

Grand Rounds

Expert’s comment concerning Grand Rounds case entitled “A case of severe and rigid congenital thoracolumbar lordoscoliosis with diastematomyelia presenting with type 2 respiratory failure: managed by staged correction with controlled axial traction” by V. Kanagaraju et al. (Eur Spine J; doi:10.1007/s00586-014-3624-0)

Original Article

Experimental validation of a patient-specific model of orthotic action in adolescent idiopathic scoliosis

Original Article

Bi-planar spinal stereoradiography of adolescent idiopathic scoliosis: considerations in 3D alignment and functional balance

Original Article

Rib-vertebral angle measurements predict brace treatment outcome in Risser grade 0 and premenarchal girls with adolescent idiopathic scoliosis

Letter to the Editor

Answers to the Letters to the Editor of P. Lambert et al. and L. G. Czaplewski concerning “Prospective study using anterior approach did not show association between Modic 1 changes and low grade infection in lumbar spine” by Rigal J, Thelen T, Byrne F, Cogniet A, Boissière L, Aunoble S, Le Huec JC (Eur Spine J [2016]; 25(4):1000–5. doi:10.1007/s00586-016-4396-5)