A microbiology study on the wounds of pediatric patients undergoing spinal fusion for scoliosis

Rudolph, Tyler; Floccari, Lorena V.; Crawford, Haemish; Field, Antony

doi:10.1007/s43390-022-00590-w

Cited by 3 publications

(4 citation statements)

References 35 publications

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“…Some infections are clearly caused by direct contamination, i.e., the spread of residual skin flora remaining after antisepsis. 3 For other SSIs, the patient's own microbiome provides the causative organism when combined with the immunologic perturbation and disruption of physiologic bacterial communities of the perioperative period [12]. For example, neutrophils may transport viable S. aureus, internalized at a colonized site such as the nares, to a site of tissue trauma such as the surgical incision.…”

Section: Discussionmentioning

confidence: 99%

“…MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions, or products referred to in the content. 2 surgical procedure [3]. It showed a higher rate of positive cultures from deep within the surgical bed prior to wound closure than immediately following surgical exposure or routine preoperative skin preparation.…”

Section: Introductionmentioning

confidence: 95%

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Dosing Cefazolin for Surgical Site Infection Prophylaxis in Adolescent Idiopathic Scoliosis Surgery: Intermittent Bolus or Continuous Infusion?

Yu,

Dooley,

Woods

et al. 2024

Preprint

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Background: Cefazolin is typically used to minimize the risk of surgical site infection (SSI) following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). Cefazolin dosing recommendations vary and there is limited evidence of the tissue concentrations achieved throughout surgery. Methods: We performed a randomized, controlled, prospective pharmacokinetic pilot study of 12 patients given cefazolin by either intermittent bolus (30mg/kg every 3 hours) or continuous infusion (30 mg/kg bolus followed by 10/mg/kg per hour throughout the surgery) during PSF for AIS. We measured plasma cefazolin concentrations and used a clinical microdialysis technique to measure skeletal muscle and subcutaneous adipose tissue concentrations. Results: Patients were well matched for demographic and perioperative variables. As expected, patients in the infusion group received more cefazolin. While global drug exposure measured as area under the curve was similar in plasma for bolus and infusion dosing, infusion dosing achieved greater cefazolin exposure in subcutaneous and muscle tissue. Using the pharmacodynamic metric of time spent below minimal inhibitory concentration both bolus and infusion dosing performed well. However, when targeting a bactericidal concentration of 32 µg/mL for the typical 6 hour operative time, patients in the bolus group spent a median of 1/5 and 1/3 of below that target in subcutaneous and muscle tissue, respectively. Conclusions: Intraoperative determination of cefazolin tissue concentrations is feasible in PSF for AIS. Both, bolus and infusion dosing of cefazolin achieve concentrations in excess of typical minimal inhibitory concentrations. Infusion dosing appears to more consistently achieve bactericidal concentrations in subcutaneous and muscle tissues.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 95%

Dosing Cefazolin for Surgical Site Infection Prophylaxis in Adolescent Idiopathic Scoliosis Surgery: Intermittent Bolus or Continuous Infusion?

Yu,

Dooley,

Woods

et al. 2024

Preprint

View full text Add to dashboard Cite

show abstract

“…Surgical site infections are likely multifactorial. Some infections are clearly caused by direct contamination, i.e., the spread of residual skin flora remaining after antisepsis [ 8 ]. For other SSIs, the patient’s own microbiome provides the causative organism when combined with the immunologic perturbation and disruption of physiologic bacterial communities of the perioperative period [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…The most common causative agents for SSI in the AIS population are skin flora such as Staphylococcus aureus and Staphylococcus epidermidis [ 7 ]. A recent study of 21 patients undergoing PSF, in which cultures were taken from the surgical site at various stages of the surgical procedure, describes a pattern of residual skin flora spreading to deeper parts of the wound in the course of the surgical procedure [ 8 ]. This showed a higher rate of positive cultures from deep within the surgical bed prior to wound closure than immediately following surgical exposure or routine preoperative skin preparation.…”

Section: Introductionmentioning

confidence: 99%

Dosing Cefazolin for Surgical Site Infection Prophylaxis in Adolescent Idiopathic Scoliosis Surgery: Intermittent Bolus or Continuous Infusion?—A Pilot Study

Yu,

Dooley,

Woods

et al. 2024

JCM

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Background: Cefazolin may minimize the risk of surgical site infection (SSI) following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). Cefazolin dosing recommendations vary and there is limited evidence for achieved tissue concentrations. Methods: We performed a randomized, controlled, prospective pharmacokinetic pilot study of 12 patients given cefazolin by either intermittent bolus (30 mg/kg every 3 h) or continuous infusion (30 mg/kg bolus followed by 10/mg/kg per hour) during PSF for AIS. Results: Patients were well matched for demographic and perioperative variables. While total drug exposure, measured as area-under-the-curve (AUC), was similar in plasma for bolus and infusion dosing, infusion dosing achieved greater cefazolin exposure in subcutaneous and muscle tissue. Using the pharmacodynamic metric of time spent above minimal inhibitory concentration (MIC), both bolus and infusion dosing performed well. However, when targeting a bactericidal concentration of 32 µg/mL, patients in the bolus group spent a median of 1/5 and 1/3 of the typical 6 h operative time below target in subcutaneous and muscle tissue, respectively. Conclusions: We conclude that intraoperative determination of cefazolin tissue concentrations is feasible and both bolus and infusion dosing of cefazolin achieve concentrations in excess of typical MICs. Infusion dosing appears to more consistently achieve bactericidal concentrations in subcutaneous and muscle tissues.

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Effect of microorganisms isolated by preoperative osseous sampling on surgical site infection after autologous cranioplasty: A single-center experience

Roblot,

Belaroussi,

Peiffer-Smadja

et al. 2023

Neurochirurgie

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A microbiology study on the wounds of pediatric patients undergoing spinal fusion for scoliosis

Cited by 3 publications

References 35 publications

Dosing Cefazolin for Surgical Site Infection Prophylaxis in Adolescent Idiopathic Scoliosis Surgery: Intermittent Bolus or Continuous Infusion?

Dosing Cefazolin for Surgical Site Infection Prophylaxis in Adolescent Idiopathic Scoliosis Surgery: Intermittent Bolus or Continuous Infusion?

Dosing Cefazolin for Surgical Site Infection Prophylaxis in Adolescent Idiopathic Scoliosis Surgery: Intermittent Bolus or Continuous Infusion?—A Pilot Study

Effect of microorganisms isolated by preoperative osseous sampling on surgical site infection after autologous cranioplasty: A single-center experience

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