Efficacy of Prophylactic Antibiotics in Spinal Surgery (척추 수술에서 예방적 항생제 사용의 유용성)

박정욱; 정남수; 서현석; Lim Oh Kyung (임오경); 전창훈

Efficacy of Prophylactic Antibiotics in Spinal Surgery

Journal of Korean Society of Spine Surgery
Abbr : J Kor Spine Sur
2013, 20(3), pp.77-85
Publisher : Korean Society Of Spine Surgery
Research Area : Medicine and Pharmacy > Orthopedic Surgery

박정욱 ¹, 정남수 ², 서현석 ², Lim Oh Kyung ³, 전창훈 ²

¹부산 부민병원 정형외과
²아주대학교
³가천대학교

Accredited

ABSTRACT

Study Design: Retrospective comparative study. Objectives: The aim of this study was to compare the efficacy of prophylactic antibiotics in spinal surgery for the occurrence of postoperative surgical site infection (SSI) and host immune reactions depending on various administration regimens and protocols. Summary of Literature Review: The superiority of one regimen or protocol of prophylactic antibiotics over others for SSI in spinal surgery has not been clearly demonstrated. We designed a controlled clinical trial to compare the occurrence of SSI with the changes of hematologic results depending on prophylaxis regimens and protocols. Materials and Methods: Between January 2007 and February 2011, two hundred consecutive patients who had undergone thoracolumbar/lumbar surgery for degenerative or traumatic disease were included. Postoperative protocol was altered for each group of fifty consecutive patients; 1st generation cephalosporins for 5-days (group A), 2nd generation cephalosporins for 5-days (group B),1st generation cephalosporins for 3-days (group C), and 2nd generation cephalosporins for 3-days (group D). Preoperative antibiotic prophylaxis was administrated within 1 hour prior to surgical incision with the same trial antibiotics. Intraoperative bacterial culture was performed from the surgical site. The occurrences of SSI were evaluated as either incisional or organ/space SSI. Serial changes in hematologic inflammatory markers (WBC, ESR, CRP) and DIC markers (fibrinogen, FDP, D-dimer) were compared until postoperative 2weeks. Results: The study groups were homogeneous regarding age, sex, body mass index, estimated blood loss, diabetes mellitus, smoking,diagnosis, baseline laboratory values, and type of surgery including instrumentation. Overall, 13 cases of incisional SSI (6.5%) and 3cases (1.5%) of organ/space SSI occurred. There was no difference in the occurrence of incisional and organ/space SSI among the 4groups (P=0.690, 0.799). Laboratory results revealed that postoperative changes in hematologic inflammatory markers and DIC markers were not influenced by prophylaxis regimens and protocols (all P>0.05). Conclusions: The occurrences of SSI and host immune responses were not influenced by postoperative antibiotics regimens and protocols. Hematologic investigation revealed that host immune responses did not depend on the type of prophylactic antibiotics.

KEYWORDS

Prophylactic antibiotics, Surgical site infection, Hematologic markers, Spine surgery, Control

Citation status

* References for papers published after 2023 are currently being built.

[journal] 안동기 / 2009 / Precautions Against Infection Following Posterior Spinal Fusion Based on Types of Infection and Risk Factors / 대한척추외과학회지 / 대한척추외과학회 16(4) : 274~284

[journal] Kim EH / 2000 / Deep Wound Infection after Lumbar Spine Fusion wigh Pedicualar Screw Fixation / J Korean soc spine surg 7 : 535~543

[journal] 송경진 / 2008 / Risk Factors of Deep Infection after Thoracic and Lumbar Spinal Arthrodesis / 대한척추외과학회지 / 대한척추외과학회 15(3) : 149~156

[journal] Shim JI / 2000 / Late Infection of Spinal Instrumentation / J Korean soc spine surg 7 : 29~36

[journal] Thalgott JS / 1991 / Postoperative infections in spinal implants. Classification and analysis--a multicenter study / Spine(Phila Pa 1976) 16 : 981~984

[journal] National Nosocomial Infections Surveillance System / 2004 / National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004 / Am J Infect Control 32 : 470~485

[journal] Barker FG 2nd / 2002 / Efficacy of prophylactic antibiotic therapy in spinal surgery : a meta-analysis / Neurosurgery 51 : 391~400

[journal] Brown EM / 2004 / Spine update : prevention of postoperative infection in patients undergoing spinal surgery / Spine(Phila Pa 1976) 29 : 938~945

[journal] Olsen MA / 2008 / Risk factors for surgical site infection following orthopaedic spinal operations / J Bone Joint Surg Am 90 : 2~9

[journal] Kanayama M / 2007 / Effective prevention of surgical site infection using a Centers for Disease Control and Prevention guideline-based antimicrobial prophylaxis in lumbar spine surgery / J Neurosurg Spine 6 : 327~329

[journal] Collins I / 2008 / The diagnosis and management of infection following instrumented spinal fusion / Eur Spine J 17 : 445~450

[journal] Petignat C / 2008 / Cefuroxime prophylaxis is effective in noninstrumented spine surgery : a double-blind, placebo-controlled study / Spine(Phila Pa 1976) 33 : 1919~1924

[journal] Kim B / 2010 / Antibiotic Microbial Prophylaxis for Spinal Surgery : Comparison between 48 and 72-Hour AMP Protocols / Asian Spine J 4 : 71~76

[journal] Pull ter Gunne AF / 2009 / Incidence, prevalence, and analysis of risk factors for surgical site infection following adult spinal surgery / Spine(Phila Pa 1976) 34 : 1422~1428

[journal] Fang A / 2005 / Risk factors for infection after spinal surgery / Spine(Phila Pa 1976) 30 : 1460~1465

[journal] Simpson JM / 1993 / The results of operations on the lumbar spine in patients who have diabetes mellitus / J Bone Joint Surg Am 75 : 1823~1829

[journal] Stambough JL / 1992 / Postoperative wound infections complicating adult spine surgery / J Spinal Disord 5 : 277~285

[journal] Wimmer C / 1998 / Predisposing factors for infection in spine surgery : a survey of 850 spinal procedures / J Spinal Disord 11 : 124~128

[journal] Kang BU / 2010 / Surgical site infection in spinal surgery : detection and management based on serial C-reactive protein measurements / J Neurosurg Spine 13 : 158~164

[journal] Sakr Y / 2007 / Antithrombin levels, morbidity, and mortality in a surgical intensive care unit / Anesth Analg 105 : 715~723

[journal] Akyildiz HY / 2010 / The value of D-dimer test in the diagnosis of patients with nontraumatic acute abdomen / Ulus Travma Acil Cerrahi Derg 16 : 22~26

[journal] Guneysel O / 2004 / Plasma d-dimer levels increase with the severity of community acquired pneumonia / Tuberk Toraks 52 : 341~347

[journal] Watters WC, 3rd / 2009 / Antibiotic prophylaxis in spine surgery : an evidence-based clinical guideline for the use of prophylactic antibiotics in spine surgery / Spine J 9 : 142~146

KJCKorea
Journal Central

Journal of Korean Society of Spine Surgery 2023 KCI Impact Factor : 0.03