Effects of extended oral antibiotic prophylaxis on surgical site infections after instrumented spinal fusion: a cohort study of 901 patients with a minimum follow-up of 1 year

Authors

  • Miguel Menendez Garcia Spine Surgery Unit, Department of Trauma and Orthopaedics, Hospital Universitario de Navarra, Pamplona (Navarra) https://orcid.org/0000-0002-8739-2152
  • Iñaki Otermin Maya Internal Medicine Department, Hospital Universitario de Navarra, Pamplona (Navarra) https://orcid.org/0000-0003-4582-214X
  • Julian Librero Lopez Research Methodology Unit, Navarrabiomed, Pamplona (Navarra), Spain https://orcid.org/0000-0002-4859-9054
  • Jorge Gutierrez Dubois Internal Medicine Department, Hospital Universitario de Navarra, Pamplona (Navarra) https://orcid.org/0000-0002-9364-2031
  • Diego Manrique Cuevas Spine Surgery Unit, Department of Trauma and Orthopaedics, Hospital Universitario de Navarra, Pamplona (Navarra)
  • Jose Ignacio Alaez Cruz Internal Medicine Department, Hospital Universitario de Navarra, Pamplona (Navarra)
  • Leyre Azcona Salvatierra Spine Surgery Unit, Department of Trauma and Orthopaedics, Hospital Universitario de Navarra, Pamplona (Navarra)
  • Isabel Ayechu Diaz Spine Surgery Unit, Department of Trauma and Orthopaedics, Hospital Universitario de Navarra, Pamplona (Navarra)
  • Angel M Hidalgo Ovejero Spine Surgery Unit, Department of Trauma and Orthopaedics, Hospital Universitario de Navarra, Pamplona (Navarra) https://orcid.org/0000-0002-3425-2789

DOI:

https://doi.org/10.2340/17453674.2023.9409

Keywords:

extended antibiotic prophylaxis, Infection, oral prophylaxis, spinal surgery, Spine, surgical site infections

Abstract

Background and purpose: We aimed to determine whether an extended oral antibiotic prophylaxis protocol may reduce the rate of surgical site infection (SSI) in patients undergoing instrumented spinal fusion.
Patients and methods: This retrospective cohort study comprise 901 consecutive patients subjected to spinal fusion between September 2011 and December 2018 with a minimum 1-year follow-up. 368 patients operated on between September 2011 and August 2014 were administered standard intravenous prophylaxis. 533 patients operated on between September 2014 and December 2018 were administered an extended protocol with 500 mg of oral cefuroxime axetil every 12 hours (clindamycin or levofloxacin in allergic individuals) until the removal of sutures. SSI was defined following the Centers for Disease Control and Prevention criteria. The association between risk factors and the incidence of SSI was evaluated by odds ratio (OR) with a multiple logistic regression model.
Results: The bivariate analysis showed a statistically significant association between SSI and the type of prophylaxis used (“extended”’ = 1.7% vs. “standard” = 6.2%, p= 0.001), with a lower proportion of superficial SSIs with the extended regimen (0.8% vs. 4.1%, p = 0.001). The multiple logistic regression model showed an OR = 0.25 (95% confidence interval [CI] 0.10–0.53) for extended prophylaxis and an OR = 3.5 (CI 1.3–8.1) for non-beta-lactams antibiotics.
Conclusion: Extended antibiotic prophylaxis seems to be associated with a reduction in the incidence of superficial SSI in instrumented spine surgery.

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References

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Published

2023-02-21

How to Cite

Menendez Garcia, M., Otermin Maya, I., Librero Lopez, J., Gutierrez Dubois, J., Manrique Cuevas, D., Alaez Cruz, J. I., … Hidalgo Ovejero, A. M. (2023). Effects of extended oral antibiotic prophylaxis on surgical site infections after instrumented spinal fusion: a cohort study of 901 patients with a minimum follow-up of 1 year. Acta Orthopaedica, 94, 80–86. https://doi.org/10.2340/17453674.2023.9409

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