Spine surgery and antibiotics- how to use them – the latest news

Antibiotic therapy is part of preoperative, intraoperative and postoperative proceedings in spine surgery. Prophylactic antibiotics are recommended to decrease the rate of infections following instrumented and unsinstrumented spine fusion (1). Most spine surgeons administer antibiotic prophylaxis even in clean procedures – when there is no break in sterile technique, no open wound, and no entry into the respiratory, gastrointestinal, or genitourinary tracts (3). It is known that in patient with risk factors appropriate broad spectrum antibiotics should be used in first place, but we do not have strict recommendation of one specific antibiotic protocol or dosing regimen over another in the prevention of postoperative infections (1). An interesting issue is how long we should use antibiotics in spine surgery.


So far, a comprehensive review of the spine literature did not yield evidence to address this question. Richelle C. Takemoto, MD, carried out research which suggest that prolonged antibiotic therapy is not beneficial for patients.He presented his findings at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons.

Richelle C. Takemoto’s research showed that when antibiotic is used for the duration when a drain is in place, almost 3 times more patients become infected (14,6%), in comparision to situation when antibiotic therapy lasts 24 hours (5,4%). The group of the examined consisted of 199 people. These were patients subjected to surgery of similar scope, examined in terms of demography as well as medical comorbidities.


The vertebral column (bones), the intervertebral discs, the dural sac (the covering around the spinal cord) or the space around the spinal cord may become infected in a number of circumstances (4).

Staphylococcus aureus is by far the most common organism found in postoperative spinal wound infections, followed by Staphylococcus epidermidis. Most infections are single organisms; only 8.3% are mixed positive and Gram-negative organisms (3).

Surgical risk factors include a long surgical time, instrumentation and re-operations. There is a certain group of people at risk. These are mostly obese people and smokers, as they have nutritional depletion and immunodeficiencies. Diabetics are also at higher risk of postoperative infection. There are no specific modifications to antibiotic protocols for them (2).

The rate of infection is proportional to the magnitude of intervention. Postoperative infections after spinal surgery have devastating consequences in terms of lengthy hospital stays, increased spinal degeneration, potential instability, and increased costs (4). Some of the most common infections of the spine’s bones and discs include osteomyelitis, discitis, and spinal epidural abscess (5). To cure the patient again, we sometimes need intravenous antibiotics and surgery. Often the removal of diseased tissue and decompression of neural structures is necessary. That is why the use of effective antiinfection protocols is becoming increasingly important.

It is possible that the results of the study by Richelle C. Takemoto, MD, will become new favourable guidelines for doctors dealing with spine. Certainly, if it was confirmed that 24-hour antibiotic therapy has a better effect in spinal surgery, it would have a positive influence on the condition of patients after surgery and would also have impact on reducing antibiotic resistance of bacteria.

Author: Jerzy Bednarski



Source:
1. http://www.guideline.gov/content.aspx?id=12191
2. North American Spine Society Evidence-Based Clinical Guidelines
for Multidisciplinary Spine Care
3. Postoperative Wound Infections of the Spine: Antibiotic Prophylactic Therapy
John M. Beiner, M.D., Jonathan Grauer, M.D., Brian K. Kwon, M.D., Alexander R. Vaccaro, M.D., Department of Orthopaedic Surgery, Thomas Jefferson University and the Rothman Institute, Philadelphia, Pennsylvania
4.http://www.knowyourback.org/Pages/SpinalConditions/InfectionsTumors/SpinalInfections.aspx Daniel R. Fassett, Darrel S. Brodke – Antibiotics in the management of spinal postoperative wound infections-Seminars in Spine Surgery, Elsevier ,September 2004
5. http://www.healthtree.com/articles/spinal-problems/bone/infection/

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