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Changes in antibiotic and irrigation procedures for spinal fusion may reduce infection rates tenfold
SAN DIEGO — Routine use of vancomycin and ceftazidime combined with pulsatile lavage can significantly reduce the rate of postoperative infection in patients with adolescent idiopathic scoliosis who undergo spinal fusion surgery, according to results presented here.
Karen Myung, MD, shared her findings at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons.
“We asked ourselves, ‘Are there simple steps we can change in our protocol to reduce the rates of infection in children undergoing spinal fusion for adolescent idiopathic scoliosis?’ ” Myung said.
Two changes
 Karen Myung |
Myung and colleagues performed a retrospective review of all spinal fusion surgeries performed for idiopathic scoliosis from 1996 to 2008 at a single institution. Two changes in protocol were implemented in 2003 — routine perioperative antibiotic prophylaxis changed from cefazolin alone to the use of vancomycin and ceftazidime, and intraoperative irrigation changed from the use of bulb syringe to 3 liters of pulsatile lavage irrigation with or without detergent.
The investigators compared the rates of postoperative infection requiring irrigation and debridement before and after the procedural changes were implemented.
Irrigation and debridement
Myung reported that before the changes, 261 spinal fusion surgeries were performed. Of these, 11% of patients underwent irrigation and debridement for postoperative infection. After the changes, 263 spinal fusion surgeries were performed with 0.7% of patients undergoing irrigation and debridement.
Myung noted that since the study investigated two simultaneous changes in procedure, it was impossible to determine the relative impact of each variable.
“However, since these are simple changes with relatively low risk, it is our current practice at this time to employ both vancomycin and ceftazidime into our routine antibiotic prophylaxis protocol in addition to a pulse lavage — decreasing our rate of infection by tenfold in the adolescent idiopathic population,” Myung concluded.
References:
- Myung K, et al. Simple steps to minimize spine infections in adolescent idiopathic scoliosis. Paper 438. Presented at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons. Feb. 14-19, 2011. San Diego.
Disclosure: Myung has no relevant financial disclosures.
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