Antibiotic prophylaxis in high-risk pediatric spine surgery: Is cefazolin enough?

Piantoni, Lucas; Tello, Carlos; Remondino, Rodrigo; Wilson, Ida A. Francheri; Galaretto, Eduardo; Bersusky, Ernesto; Noël, Mariano A.

doi:10.1007/s43390-020-00092-7

Cited by 6 publications

(7 citation statements)

References 34 publications

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“…Therefore, adding prophylaxis for gram-negative bacilli should be considered. 9 Other studies also support the incorporation of aminoglycosides in prophylactic protocols in these patients. 15,16 These conclusions align with the BPG statement that "patients with neuromuscular disease should receive perioperative intravenous prophylaxis for gram-negative bacilli for an insertion procedure."…”

Section: Discussionmentioning

confidence: 90%

“…SSI is an important and common complication after growth-friendly procedures in EOS patients. [4][5][6][7][8][9] This study analyzes antibiotic prophylaxis at the time of index growth-friendly procedures in EOS patients and assesses change in practice over time after BPG publication for SSI prevention. We found considerable variation in antibiotic prophylaxis for EOS patients, though there has been a significant increase in usage of intravenous cefazolin with an aminoglycoside after BPG publication.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 The most common postoperative complication in EOS patients is surgical site infection (SSI) 4 with a reported incidence of up to 42%. [4][5][6][7][8][9] Risk factors for SSI in EOS patients include the use of growing rods compared with standard spinal fusion; comorbid conditions, particularly cerebral palsy or myelodysplasia; nonambulatory status; revision surgery; and stainless steel implant use. 7,10 Neuromuscular causes, larger magnitude major curve, and larger magnitude kyphotic angle also appear to increase SSI risk.…”

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confidence: 99%

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Intraoperative Antibiotic Use in Patients With Early-onset Scoliosis: Current Practices and Trends

Faust

Allahabadi

Louer

et al. 2023

Journal of Pediatric Orthopaedics

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Background: Best Practice Guidelines (BPGs) regarding antibiotic prophylaxis in early-onset scoliosis (EOS) patients were published in September 2019. Recommendations included using intravenous cefazolin and topical vancomycin for all index procedures, plus gram-negative coverage for neuromuscular patients. Guideline adherence is unknown. This study aimed to characterize antibiotic prophylaxis at the time of index growth-friendly procedures and assess changes in practice patterns over time. Materials and Methods: This retrospective review of data collected through a multicenter study group included EOS patients undergoing index growth-friendly procedures between January 2018 and March 2021, excluding revisions, lengthenings, and tetherings. Demographics, clinical measurements, intraoperative antibiotics, and 90-day complications were recorded. Descriptive and univariate statistics were utilized. Antibiotic prophylaxis from April 2018 through September 2019 and October 2019 through March 2021 were compared with evaluate change after BPG publication. Results: A total of 562 patients undergoing growth-friendly procedures were included. The most common scoliosis types included neuromuscular (167, 29.7%), syndromic (134, 23.8%), and congenital (97, 17.3%). Most index procedures involved magnetically controlled growing rods (417, 74%) followed by vertical expandable prosthetic titanium rib or traditional growing rods (105, 19%). Most patients received cefazolin alone at index procedure (310, 55.2%) or cefazolin with an aminoglycoside (113, 20.1%). Topical antibiotics were used in 327 patients (58.2%), with most receiving vancomycin powder. There was increased use of cefazolin with an aminoglycoside after BPG publication (16% vs. 25%) (P = 0.01). Surgical site infections occurred in 12 patients (2.1%) within 90 days of index procedure, 10 pre-BPGs (3%), and 2 post-BPGs (0.9%), with no significant difference in surgical site infection rate by type of antibiotic administered (P > 0.05). Conclusions: Historical variability exists regarding antibiotic prophylaxis during index growth-friendly procedures for EOS. There continues to be variability following BPG publication; however, this study found a significant increase in antibiotic prophylaxis against gram-negative bacteria after BPG publication. Overall, greater emphasis is needed to decrease variability in practice, improve compliance with consensus guidelines, and evaluate BPG efficacy. Level of Evidence: Level III-retrospective.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Intraoperative Antibiotic Use in Patients With Early-onset Scoliosis: Current Practices and Trends

Faust

Allahabadi

Louer

et al. 2023

Journal of Pediatric Orthopaedics

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“…Surgery at different locations should consider covering different types of bacteria when preventing infections. A retrospective study of spinal surgery 58 included 1410 pediatric patients using cefazolin for prevention. SSIs occurred in 68 patients (4.8%), and bacterial culture was positive in 48 patients, among them, 72% were Gram‐negative bacterial infection.…”

Section: Resultsmentioning

confidence: 99%

Evidence‐based guideline for the prevention and management of perioperative infection

Wang

Cao

Tao

et al. 2023

J Evidence Based Medicine

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Background:We have updated the guideline for preventing and managing perioperative infection in China, given the global issues with antimicrobial resistance and the need to optimize antimicrobial usage and improve hospital infection control levels. Methods:We conducted a comprehensive evaluation of the evidence for prevention and management of perioperative infection, based on the concepts of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The strength of recommendations was graded and voted using the Delphi method and the nominal group technique. Revisions were made to the guidelines in response to feedback from the experts.Results: There were 17 questions prepared, for which 37 recommendations were made. According to the GRADE system, we evaluated the body of evidence for each 52 WANG ET AL. clinical question. Based on the meta-analysis results, recommendations were graded using the Delphi method to generate useful information. Conclusions:This guideline provides evidence to perioperative antimicrobial prophylaxis that increased the rational use of prophylactic antimicrobial use, with substantial improvement in the risk-benefit trade-off.

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“…When patients present with multiple significant risk factors for SSI, considering more comprehensive antibiotic prophylaxis may be beneficial. For example Piantoni et al26 make a case for extending prophylaxis to include coverage of gram-negative bacteria for some high-risk pediatric spinal patients, among whom these microbes may be especially common. A retrospective study of pediatric spine patients by Vandenberg et al27 demonstrated reduced rates of SSI after the implementation of an antibiotic protocol including the expansion of prophylaxis to include preoperative vancomycin for all patients 13 years or older and ceftriaxone for expanded coverage of gram-negative organisms for patients who were deemed high risk.…”

Section: Expanded Antibiotic Coveragementioning

confidence: 99%

Update on Perioperative Antibiotic Strategy for Spine Surgery

Lynch¹,

Jadczak²,

Elliot³

et al. 2021

Contemporary Spine Surgery

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Lippincott Continuing Medical Education Institute, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Lippincott Continuing Medical Education Institute, Inc., designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. To earn CME credit, you must read the CME article and complete the quiz and evaluation assessment survey on the enclosed form, answering at least 70% of the quiz questions correctly. This activity expires on May 31, 2023.LEARNING OBJECTIVES: After participating in this CME activity, the spine surgeon should be better able to: 1. Describe current guidelines and evidence regarding antibiotic prophylaxis for spine surgery. 2. Identify patient-and procedure-specific factors that may influence optimal antibiotic choice.

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Antibiotic prophylaxis in high-risk pediatric spine surgery: Is cefazolin enough?

Cited by 6 publications

References 34 publications

Intraoperative Antibiotic Use in Patients With Early-onset Scoliosis: Current Practices and Trends

Intraoperative Antibiotic Use in Patients With Early-onset Scoliosis: Current Practices and Trends

Evidence‐based guideline for the prevention and management of perioperative infection

Update on Perioperative Antibiotic Strategy for Spine Surgery

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