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Study shows antibiotic prophylaxis and drain use may not lower infection risk
SSI rates were 12.4% when antibiotic prophylaxis was given for more than 24 hours after postoperatively.
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Drains are commonly used after spine surgery to help decrease wound drainage and potentially reduce infection rates, but according to a recently published study, when drain use was combined with antibiotic prophylaxis for 24 hours after surgery the surgical site infection rates were unchanged.
Cost containment is a major issue in the medical field and unnecessary treatments, such as this, can lead to higher procedural costs, according to Thomas J. Errico, MD, chief of the Division of Spine Surgery at NYU Langone Medical Center in New York City.
“We struggle to gain evidence to guide our day-to-day decisions. Variations in care based on preference or intuition are to be avoided,” Errico, a co-author of this study, told Spine Surgery Today.
“Although stopping prophylactic antibiotics at 24 hours after spinal surgery seemed to be the appropriate guideline, we found many surgeons in our unit were keeping the antibiotics longer, based on the presence of drains. While this seemed to them intuitively correct, we lacked the evidence to support this. Our study simply showed that by using CDC criteria, our superficial wound infection rates seemed higher than we thought. But clearly, maintaining antibiotics for the duration of the drains being in place did not minimize the infection rates and it tended to increase the problem,” he said.
No difference in infection rates
The prospective, randomized trial conducted by Errico and colleagues involved 314 patients who underwent multilevel thoracolumbar surgery and received a drain postoperatively. In all, 170 patients received antibiotic prophylaxis for 24 hours after their surgery and 144 patients received antibiotic prophylaxis for the entire time the drain was in place after their surgery.
The surgical site infection (SSI) rates defined by the CDC were the primary endpoints used in the study.
SSIs were present in 21 patients of the 170 patients who received antibiotics for 24 hours for a rate of 12.4%. They were present in 19 patients in the drain-duration group for a rate of 13.2%. The difference in SSI rates for the two groups was not statistically significant
Exceeding 24 hours: no difference
The mean duration for drain placement was 3 days in patients who received antibiotics for 24 hours and 3.2 days for patients who received antibiotics for more than 24 hours (P = .4), according to the findings.
An SSI developed in 40 patients (12.7%) of the 314 patients who received a drain during a spine procedure andnine patients (7%) developed an infection among the 129 patients who did not receive a drain.
The administration of antibiotics for longer than 24 hours after spine surgery when a drain is in place is not effective in reducing SSI in these patients, Errico and colleagues concluded. – by Robert Linnehan
- Reference:
- Takemoto RC, et al. J Bone J Surg Am. 2015;doi:10.2106/JBJS.L00782.
- For more information:
- Thomas J. Errico, MD, can be reached at NYU Langone Medical Center, 333 E. 38th St., New York, NY 10016; email: thomas.errico@nyumc.org.
Disclosure: The investigators report one or more of the authors, or his or her institution, has had a financial relationship, in the past 36 months prior to submission of this work. This is an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work.
Perspective
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Claudia Eder, MD
Surgical site infections (SSI) are a major complication in spine surgery and have a profound impact on the patients life and the costs for the health care system. The prolonged usage of suction drains, which are commonly applied after spinal surgery to prevent hematoma formation, represents an independent risk factor. For this reason, prophylactic antibiotics are often administered for the duration that a drain is in place. This practice is not without controversy, as the increased use of antibiotics may foster bacterial resistance.
This interesting study compares infection rates in spinal surgery patients after 24 hours vs. prolonged antibiotic prophylaxis. The authors report no reduction of infection rates in cases of prolonged antibiotic administration. Although their overall infection rate is rather high (which may be explained by the application of the CDC-criteria for diagnosis of SSI), their results are in accordance with previous studies and should therefore lead to a reconsideration of prolonged antibiotic prophylaxis.
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