Effective prevention of surgical site infection using a Centers for Disease Control and Prevention guideline–based antimicrobial prophylaxis in lumbar spine surgery

2007 ◽  
Vol 6 (4) ◽  
pp. 327-329 ◽  
Author(s):  
Masahiro Kanayama ◽  
Tomoyuki Hashimoto ◽  
Keiichi Shigenobu ◽  
Fumihiro Oha ◽  
Daisuke Togawa
Keyword(s):  
Single Dose ◽  
Lumbar Spine ◽  
Surgical Site Infection ◽  
Spine Surgery ◽  
Multiple Dose ◽  
Dose Group ◽  
Antimicrobial Prophylaxis ◽  
Lumbar Spine Surgery ◽  
Site Infection ◽  
Control And Prevention

Object Antimicrobial prophylaxis (AMP) reduces the rate of surgical site infection (SSI) in lumbar spine surgery, but a great deal of variation exists regarding the timing and duration of AMP. The authors had previously used prophylactic antibiotics for 5 to 7 postoperative days. Based on the Centers for Disease Control and Prevention (CDC) guideline, the AMP period was changed to the day of surgery only. In the current study, the authors compared the rate of SSI in lumbar spine surgeries between two different protocols of AMP. Methods Data from 1597 consecutive uninfected patients who had undergone lumbar spine surgery between January 1999 and September 2004 were reviewed. The pathophysiologies among these patients included disc herniation in 686, degenerative spondylolisthesis in 340, spinal stenosis in 259, failed lumbar surgeries in 73, degenerative scoliosis in 52, isthmic spondylolisthesis in 48, spinal trauma in 34, foraminal stenosis in 27, spinal tumor in 27, and miscellaneous in 51 patients. The rate of SSI was compared between the two AMP groups. There were 1133 patients in the multiple-dose group, and 464 patients in the single-dose group. The rate of instrumentation surgery was not statistically different between the multiple-dose group (43%) and the single-dose group (39%). The overall rate of SSI was 0.7%. The SSI rate was 0.8% in the multiple-dose group and 0.4% in the single-dose group; the difference between the two was not significant. Regarding the organisms of SSI, resistant strains of bacteria were cultured in five (83.3%) of six patients in the multiple-dose group, whereas none was cultured in the single-dose group. Conclusions Data in the current study did not demonstrate a difference in the rate of SSI between the two different AMP protocols. Based on the CDC guideline, a single dose of AMP was proven to be efficacious for the prevention of SSI in lumbar spine surgeries. A shorter duration of first-generation cephalosporin use may effectively prevent the emergence of antibiotic-resistant bacterial infection.

scholarly journals A Prospective Randomized Study to Assess the Optimal Duration of Intravenous Antimicrobial Prophylaxis in Elective Gastric Cancer Surgery

2012 ◽  
Vol 97 (2) ◽  
pp. 169-176 ◽  
Author(s):  
Norihiro Haga ◽  
Hideyuki Ishida ◽  
Toru Ishiguro ◽  
Kensuke Kumamoto ◽  
Keiichiro Ishibashi ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Single Dose ◽  
Multiple Dose ◽  
Dose Group ◽  
Antimicrobial Prophylaxis ◽  
Randomized Study ◽  
Surgical Site Infections ◽  
Cancer Surgery ◽  
Site Infection ◽  
Gastric Cancer Surgery

Abstract The duration of antimicrobial prophylaxis in gastric cancer surgery is not yet established. This prospective randomized study was performed to confirm the noninferiority of single-dose versus multiple-dose antimicrobial prophylaxis in terms of the incidence of surgical-site infection in gastric cancer surgery. Three hundred twenty-five patients undergoing elective resection for gastric cancer were randomized to receive only single-dose cefazolin (1 g) during surgery (single-dose group) or an additional 5 doses every 12 hours postoperatively (multiple-dose group). The overall incidence of surgical-site infections was 9.1% in the single-dose group and 6.2% in the multiple-dose group [difference (95% confidence interval): −2.9% (−5.9%–0.0%)]. Multivariate logistic regression analysis identified blood loss, being overweight, and advanced age as significant independent risk factors for surgical-site infection. Single-dose antimicrobial prophylaxis seemed to be acceptable, and choosing multiple-dose prophylaxis may have little impact on the prevention of surgical-site infections in elective gastric cancer surgery.

Impact of MSSA screening on rates of surgical site infection following lumbar spine surgery

2018 ◽  
Vol 27 (10) ◽  
pp. 2457-2462 ◽  
Author(s):  
Mark Higgins ◽  
Rajendrenadh Bommireddy ◽  
Faiz Shivji ◽  
Jaber Al-Shukri ◽  
James Billson
Keyword(s):  
Lumbar Spine ◽  
Surgical Site Infection ◽  
Spine Surgery ◽  
Lumbar Spine Surgery ◽  
Site Infection

scholarly journals Surgical Site Infection Prevention Following Spine Surgery

2020 ◽  
Vol 10 (1_suppl) ◽  
pp. 92S-98S ◽  
Author(s):  
Ilyas S. Aleem ◽  
Lee A. Tan ◽  
Ahmad Nassr ◽  
K. Daniel Riew
Keyword(s):  
Literature Review ◽  
Surgical Site Infection ◽  
Spine Surgery ◽  
Antimicrobial Prophylaxis ◽  
Tight Glycemic Control ◽  
Site Infection ◽  
Skin Preparation ◽  
Cervical Spine Surgery ◽  
Cervical Surgery ◽  
Posterior Cervical Surgery

Study Design: Literature review. Objectives: Surgical site infection (SSI) following spine surgery leads to significant patient morbidity, mortality, and increased health care costs. The purpose of this article is to identify risk factors and strategies to prevent SSIs following spine surgery, with particular focus on avoiding infections in posterior cervical surgery. Methods: We performed a literature review and synthesis to identify methods that can be used to prevent the development of SSI following spine surgery. Specific pearls for preventing infection in posterior cervical spine surgery are also presented. Results: SSI prevention can be divided into patient and surgeon factors. Preoperative patient factors include smoking cessation, tight glycemic control, weight loss, and nutrition optimization. Surgeon factors include screening and treatment for pathologic microorganisms, skin preparation using chlorhexidine and alcohol, antimicrobial prophylaxis, hand hygiene, meticulous surgical technique, frequent irrigation, intrawound vancomycin powder, meticulous multilayered closure, and use of closed suction drains. Conclusion: Prevention of SSI following spine surgery is multifactorial and begins with careful patient selection, preoperative optimization, and meticulous attention to numerous surgical factors. With careful attention to various patient and surgeon factors, it is possible to significantly reduce SSI rates following spine surgery.

Evaluation of a Single-Dose, Extended-Release Epidural Morphine Formulation for Pain Control After Lumbar Spine Surgery

2014 ◽  
Vol 23 (01) ◽  
pp. 9-12 ◽  
Author(s):  
Joseph C. Vineyard ◽  
John S. Toohey ◽  
Arvo Neidre ◽  
Guy Fogel ◽  
Robert Joyner
Keyword(s):  
Single Dose ◽  
Lumbar Spine ◽  
Spine Surgery ◽  
Pain Control ◽  
Epidural Morphine ◽  
Extended Release ◽  
Lumbar Spine Surgery

scholarly journals The Use of Vacuum Dressings for Dead Space Management in Deep Surgical Site Infections Allows Implant and Bone Graft Retention

2017 ◽  
Vol 7 (8) ◽  
pp. 756-761 ◽  
Author(s):  
James P. Watt ◽  
Robert N. Dunn
Keyword(s):  
Surgical Site Infection ◽  
Bone Graft ◽  
Spine Surgery ◽  
Surgical Site Infections ◽  
Lumbar Spine Surgery ◽  
Causative Organism ◽  
Site Infection ◽  
Space Management ◽  
Acute Wound ◽  
Deep Surgical Site Infection

Study Design: Retrospective, descriptive study. Objectives: Managing early surgical site infection following elective lumbar spine surgery remains a challenge with controversy regarding retention of instrumentation and bone graft. Wound closure may also pose considerable challenges. We aim to report on our method of managing deep surgical site infections complicating elective spine surgery with surgeon assembled deep vacuum dressings. Identification of causative organisms with their sensitivities was a secondary objective. Methods: Patients were identified from a prospectively maintained, single-surgeon database from 2003-2015. Patients who had an infective or trauma related diagnosis, cervical procedures, and were younger than 18 years were excluded. Records were reviewed to identify bacteriology, laboratory tests performed, antibiotics administered, and type and frequency of surgical management. One thousand two hundred twenty patients qualified for inclusion, with 19 identified as having developed acute wound sepsis. Results: All patients had surgical debridement on the day of presentation and the majority of wounds were managed with a vacuum dressing. In all but 1 patient was instrumentation retained. Specimens for culture were taken at each debridement and antibiotics changed accordingly. Patients received a minimum 6 weeks of antibiotics. Conclusions: The management of deep surgical site infection is labor intensive and frustrating for both surgeon and patient due to the unexpected prolonged admission. Management goals are identification and eradication of the causative organism with subsequent healing of the surgical wound. This process is enhanced with the use of negative-suction dressings made from theatre stock replaced at regular intervals and allows retention of bone graft and instrumentation in the majority of cases.

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