Postoperative Prophylactic Antibiotics in Spine Surgery

Abola, Matthew V.; Lin, Charles C.; Lin, Lawrence J.; Schreiber-Stainthorp, William; Frempong-Boadu, Anthony; Buckland, Aaron J.; Protopsaltis, Themistocles S.

doi:10.2106/jbjs.20.00934

Cited by 13 publications

(9 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…To circumvent this problem, two studies attempted long-term prophylactic use of four antibiotics on a cyclical regimen; this method resulted in fewer yearly UTIs in SCI individuals [ 121 , 122 ]. Prophylactic antibiotic treatment has also been recommended by the North American Spine Society in cases of spinal surgery [ 123 ], with clinical studies often, but not always, indicating a reduction in post-operative infections, particularly with multiple days of treatment [ 124 , 125 ]. How these treatments might affect other types of infections in SCI persons remains unknown.…”

Section: Potential Interventions To Improve Immunological Function Post-scimentioning

confidence: 99%

Peripheral Immune Dysfunction: A Problem of Central Importance after Spinal Cord Injury

Jeffries

Tom

2021

Biology

View full text Add to dashboard Cite

Individuals with spinal cord injuries (SCI) exhibit increased susceptibility to infection, with pneumonia consistently ranking as a leading cause of death. Despite this statistic, chronic inflammation and concurrent immune suppression have only recently begun to be explored mechanistically. Investigators have now identified numerous changes that occur in the peripheral immune system post-SCI, including splenic atrophy, reduced circulating lymphocytes, and impaired lymphocyte function. These effects stem from maladaptive changes in the spinal cord after injury, including plasticity within the spinal sympathetic reflex circuit that results in exaggerated sympathetic output in response to peripheral stimulation below injury level. Such pathological activity is particularly evident after a severe high-level injury above thoracic spinal cord segment 6, greatly increasing the risk of the development of sympathetic hyperreflexia and subsequent disrupted regulation of lymphoid organs. Encouragingly, studies have presented evidence for promising therapies, such as modulation of neuroimmune activity, to improve regulation of peripheral immune function. In this review, we summarize recent publications examining (1) how various immune functions and populations are affected, (2) mechanisms behind SCI-induced immune dysfunction, and (3) potential interventions to improve SCI individuals’ immunological function to strengthen resistance to potentially deadly infections.

show abstract

Section: Potential Interventions To Improve Immunological Function Post-scimentioning

confidence: 99%

Peripheral Immune Dysfunction: A Problem of Central Importance after Spinal Cord Injury

Jeffries

Tom

2021

Biology

View full text Add to dashboard Cite

show abstract

“…19,34 Although the relationship between C. difficile and increased morbidity, mortality, cost, and hospital length of stay has been demonstrated in spine surgery cohorts, [35][36][37] little work has examined the relationship between postoperative antimicrobial duration and C. difficile incidence in spinal surgery. One large-scale retrospective study did find that 24 hours of postoperative antimicrobial agents did not increase C. difficile rates as compared to no postoperative antimicrobial agents, 38 but the common practice of extending postoperative antimicrobials while drains remain in place has not been specifically studied. A reduction in C. difficile is especially favorable in patients undergoing lumbar surgery due to reduction in the risk of wound contamination.…”

Section: Discussionmentioning

confidence: 99%

The effects of avoiding extended antimicrobial drain prophylaxis on Clostridioides difficile and postprocedural infection rates: a 5-year retrospective

Marino

Robinson

Durden

et al. 2022

Journal of Neurosurgery

View full text Add to dashboard Cite

OBJECTIVE Postprocedural infection is a consequential complication of neurosurgical intervention. Periprocedural antimicrobial prophylaxis is routinely administered to prevent infection, and in some cases, continued for extended periods while surgical drains remain in place. However, there is little evidence that extended antimicrobial administration is necessary to reduce postprocedural infection, and extended antimicrobials can be associated with harm, such as Clostridioides difficile infection. The authors sought to evaluate whether shortening the duration of postprocedural antimicrobial prophylaxis would decrease the incidence of C. difficile infection without increasing the incidence of postprocedural infection. METHODS In this retrospective study, two general neurosurgical cohorts were examined. In one cohort, postoperative antimicrobial prophylaxis was limited to 24 hours; in the other, some patients received extended postoperative antimicrobial prophylaxis while surgical drains or external ventricular drains (EVDs) remained in place. Rates of infection with C. difficile as well as postprocedural infection after surgery and EVD placement were compared. RESULTS Seven thousand two hundred four patients undergoing 8586 surgical procedures and 413 EVD placements were reviewed. The incidence of C. difficile infection decreased significantly from 0.5% per procedural encounter to 0.07% with the discontinuation of extended postprocedural antibiotics within 90 days of a procedure. Rates of postprocedural infection and EVD infection did not significantly change. Results were similar in subgroups of patients with closed suction drains as well as cranial and spine subgroups. CONCLUSIONS Discontinuation of extended antimicrobial prophylaxis was associated with a significant decrease in the incidence of C. difficile infection without a concomitant change in postprocedural infections or EVD-associated infection. This study provides evidence in support of specialtfy-wide discontinuation of extended postoperative antimicrobial prophylaxis, even in the presence of closed suction drains.

show abstract

“…To date, harmful induction of antibiotics-resistant infections has not been confirmed in this situation. 30…”

Section: Treatment Optionsmentioning

confidence: 99%

“…To date, harmful induction of antibiotics-resistant infections has not been confirmed in this situation. 30 Additional postoperative complications include the development of an additional Charcot lesion either within the affected segment or adjacent region. 13 Ongoing clinical and radiological postoperative surveillance is warranted in this patient population.…”

Section: Postoperative Considerationsmentioning

confidence: 99%

Charcot Arthropathy of the Spine

Farrugia

Bednar

Oitment

2022

J Am Acad Orthop Surg

View full text Add to dashboard Cite

Charcot arthropathy of the spine (CSA), also known as spinal neuroarthropathy, is a progressive disease process in which the biomechanical elements of stability of the spine are compromised because of the loss of neuroprotection leading to joint destruction, deformity, and pain. Initially thought to be associated with infectious causes such as syphilis; however in the latter part of the century, Charcot arthropathy of the spine has become associated with traumatic spinal cord injury. Clinical diagnosis is challenging because of the delayed presentation of symptoms and concurrent differential diagnosis. Although radiological features can assist with diagnosis, the need for recognition and associated treatment is vital to limit the lifelong disability with the disease. The goals of treatment are to limit symptoms and provide spinal stabilization. Surgical treatment of these patients can be demanding, and alternative techniques of instrumentation are often required. Charcot arthropathy may affect all axial and peripheral joints with the knee, foot, and spine being predominantly affected. 1 Also known as spinal neuroarthropathy (SNA), Charcot spinal arthropathy is a progressive disorder involving a destructive process of the anatomical elements which provide spinal stability. Clinical recognition is often delayed and difficult. 1 The mobile thoracolumbar and lumbosacral junctions of the spine are the most common areas affected. 2 Involvement of the cervical, thoracic, or sacral regions is exceptional. 1 The pathophysiology of this disorder can mimic an infectious or malignant process. Therefore, it is paramount to be aware of the clinical and radiographic specific features and varied treatment options for Charcot spinal arthropathy. 1,2 EpidemiologyCharcot arthropathy was described by Jean-Marie Charcot in 1868, 2 in his observations of patients with joint arthropathies experiencing sharp, quick pains before the ensuing joint destruction and eventual development of ataxia. 3 Charcot arthropathy of the spine (CSA) was first described in the 1800s by physicians Mitchell and Kronig 4,5 in case reports of associations between patients with spinal cord lesions due to syphilis and incidences of peripheral neuropathy. With the modernized treatment for syphilis and

show abstract

Postoperative Prophylactic Antibiotics in Spine Surgery

Cited by 13 publications

References 27 publications

Peripheral Immune Dysfunction: A Problem of Central Importance after Spinal Cord Injury

Peripheral Immune Dysfunction: A Problem of Central Importance after Spinal Cord Injury

The effects of avoiding extended antimicrobial drain prophylaxis on Clostridioides difficile and postprocedural infection rates: a 5-year retrospective

Charcot Arthropathy of the Spine

Contact Info

Product

Resources

About