Is Postoperative Antimicrobial Prophylaxis Needed for the Management of Surgical Site Infection after Spinal Instrumentation Surgery?

Background: It is widely accepted that postoperative Antimicrobial Prophylaxis (AMP) is effective in reducing the risk of surgical site infections (SSI) following spinal surgery. After publication of the Guideline for Prevention of Surgical Site Infection by the Centers for Disease Control and Prevention in 1999, a large number of studies confirmed the effectiveness of AMP. Due to the possible emergence of AMP resistant bacteria or appearance of side-effects, we have treated and managed patients who underwent spinal surgery without post operative antimicrobial agents since 2003. Purpose: To investigate the incidence of SSI in patients without administration of antibiotics after spinal instrumentation surgery. Subjects: A consecutive 468 patients (230 males and 238 females) were adopted in this study from November 2003 to June 2010. Mean age at the time of operation was 52.1 years. We defined this group as the non-postoperative dose group. There were 121 patients (25.9%) who underwent instrumentation surgery. On the other hand, we defined patients who were administered postoperative multiple doses of AMP between January 2000 and October 2003 as the postoperative dose group. There were 340 cases, consisting of 198 males and 142 females in this group. Average age at the time of operation was 51.3 years. There were 146 patients (42.9%) who underwent spinal instrumentation surgery. Methods: All patients were administered 1 g of cefazolin within 30 minutes of skin incision, and the same dose of antimicrobial agent was added every four hours during surgery in the non-postoperative dose group. We administered AMP before and for 7 days after surgery in the postoperative dose group. Results: The postoperative infection rate was 1.92% (9 cases), of which 7 cases were superficial infections and 2 cases were deep infections in the non-post operative dose group. In the post operative dose group, there were 9 confirmed post operative wound infections in the 340 patients for an overall SSI rate of 2.65%. There was no significant difference between the two groups. The incidence of SSI in patients who underwent spinal instrumentation surgery was 0.83% (one of 121 patients) in the non-postoperative dose group and 2.04% (three of 147 patients) in the postoperative dose group. There was no significant difference between the two groups even with the use of spinal implants. Conclusions: The duration of antimicrobial prophylaxis was not related to the SSI rate at our institution. Postoperative administration of antibiotics appears to be unnecessary for spinal surgery even with spinal implants when perioperative management was achieved for the patient condition and surroundings as recommended in the CDC guidelines. *Corresponding author: Takuya Numasawa, Department of Orthopaedic Surgery, Public Noheji Hospital, 9-12 Narusawa, Noheji, Aomori, 039-3141, Japan, Tel: +81175-64-3211; Fax: +81-175-64-5571; E-mail: [email protected] Received January 23, 2015; Accepted March 20, 2015; Published March 22, 2015 Citation: Numasawa T, Ono A, Wada K, Yamasaki Y, Kumagai G, et al. (2015) Ispostoperative Antimicrobial Prophylaxis Needed for the Management of Surgical Site Infection after Spinal Instrumentation Surgery? J Spine 4: 219. doi:10.4172/21657939.1000219 Copyright: © 2015 Numasawa T, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Introduction Postoperative surgical site infection (SSI) is a significant complication in spine surgery because it may require a reoperation to control local infection and to prevent septic condition. The incidence of SSI is reported to be from less than 1% in decompressive surgery to 10% in instrumentation surgery [1-5]. The American Centers for Disease Control and Prevention (CDC) proposed a guideline for the prevention of SSI in 1999 [6]. In the guideline, there were many factors that were recommended to prevent SSI in the perioperative management. For example, the care for the condition of the patient [7], the surgical site, the operator [8] and the operating room [9] are all important factors in preoperative and intraoperative management. Also, drainage [10] and surgical site care [11] are also important as postoperative management. Moreover, the use of anti microbial prophylaxis (AMP) has been documented to play a significant role in reducing the rate of SSI. There were many topic points about antibiotic prophylaxis in spine surgery included in the North American Spine Society evidenced-based clinical guidelines in 2007 [12]. They included efficacy, protocol, redosing, discontinuation, wound drains, body habitus, and comorbidities. It was pointed out that there was poor evidence as to whether AMP results in decreased infection rate as compared to patients who do not receive prophylaxis according to the guideline. After the publication of the NASS guidelines, Kanayama et al. [13] reported the rate of SSI was not different between single day dose administration based on the CDC guidelines and multiple day doses of AMP in lumbar spine surgery with or without implants. However, nowhere in the current literature are there consistent recommendations regarding the duration of administration of postoperative antibiotics in spine Citation: Numasawa T, Ono A, Wada K, Yamasaki Y, Kumagai G, et al. (2015) Is Postoperative Antimicrobial Prophylaxis Needed for the Management of Surgical Site Infection after Spinal Instrumentation Surgery? J Spine 4: 219. doi:10.4172/21657939.1000219