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Limiting antibiotics to 24 hours after spinal surgery may decrease risk for infection

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Continued use of perioperative antibiotics for the duration that a postoperative drain is in place may not decrease the rate of surgical site infections in spinal surgery.

“Infections of the spine exact a high financial toll on the patient and the medical system,” Richelle C. Takemoto, MD, said during a presentation at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons. “In the arthroplasty literature, it has been shown there is no benefit for greater than 24 hours of antibiotics, and that greater than 24 hours of antibiotics can promote nosocomial infections … [Some] spine surgeons have been worried that the evidence from the total joint literature does not apply to spinal fusion.”

To determine whether there is a difference in the incidence of infection, Takemoto and colleagues compared the use of antibiotics for 24 hours with the use of antibiotics for the duration that the drain was in place.

The investigators studied 199 patients who underwent multilevel thoracolumbar spine surgery that required a postoperative drain. One hundred and ten patients were randomized to receive 24 hours of perioperative antibiotics, and eighty-nine patients received antibiotics for the duration that the drain was in place. The investigators collected data regarding demographics, medical comorbidities, type of spine surgery and incidence of surgical site infection.

The investigators discovered that 5.4% of patients in the 24-hour antibiotic group developed a surgical site infection. The group that received antibiotics for the duration of the postoperative drain saw an infection rate of 14.6%. Demographics, surgical time, type of surgery, drain output and length of stay were all said to be similar between the groups.

“Antibiotics should be limited to 24 hours regardless of how long a postoperative drain is left in place,” Takemoto concluded. “In the future, we plan on examining delayed infection and comparing our cohort of patients to the overall infection rate at our institution.”

Disclosures: Dr. Takemoto has no relevant financial disclosures.

For more information:

• Takemoto RC. #262. Presented at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons. Feb. 14-19, 2011. San Diego.

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