Single-dose vs multiple-dose antibiotic prophylaxis in instrumented lumbar fusion—a prospective study

Clinical practice guidelines for antimicrobial prophylaxis in surgery

“…The SSI rate in patients receiving antimicrobial prophylaxis undergoing spinal procedures with instrumentation has ranged from 2.8% to 9.7%. 165,764,765,769,770 Monosegmental instrumentation has a reported SSI rate of <2%, compared with 6.7% for instrumentation at multiple levels. 771 Several case-control studies of adults undergoing spinal procedures with and without instrumentation have found the following notable patient-related risk factors for SSI: prolonged preoperative hospitalization, 771 [770][771][772][773][774][775]777 Procedure-related risk factors include extended duration of procedure (defined in studies as two to five hours or greater than five hours, 775 greater than three hours, 771 and greater than five hours 776 ), excessive blood loss (>1 L), 771,775 staged procedure, 776 multilevel fusions, 777 foreign-body placement (e.g., screw, rod, plate), 767 combined anterior and posterior fusion, 776 and suboptimal antimicrobial timing (>60 minutes before or after incision).…”

“…There is no clearly superior antimicrobial agent or regimen for spinal procedures. 563,769 The antimicrobials most often studied for prophylaxis in orthopedic procedures are first-generation cephalosporins, particularly cefazolin. Cefazolin has been noted as a suitable agent for spinal procedures with its spectrum of activity (e.g., against Staphylococcus species and gram-negative bacilli such as E. coli) and adequate tissue 121 and disk concentrations.…”

“…8 Broader coverage may be considered for instrumented fusion due to the risk of polymicrobial infections, including those caused by gramnegative bacteria. 563,769 Clindamycin and vancomycin have adequate activity against the most common pathogens involved in orthopedic procedures and would be acceptable alternatives under certain circumstances, such as prophylaxis for patients with a b-lactam allergy. Vancomycin should be included with cefazolin or used as an alternative agent for routine antimicrobial prophylaxis for patients who are known to be colonized with MRSA.…”

“…732 There is no high-quality evidence supporting a duration of >24 hours, 782 and some sources recommend only a single preoperative dose. 8,769,778 Pediatric efficacy. While no studies have evaluated the efficacy of antimicrobial prophylaxis in pediatric patients undergoing spinal procedures with or without instrumentation, the incidence and risk factors for SSIs in this population have been reported.…”

Infections associated with spinal implants

“…There is a difference of opinion with regard to the duration of these injections but the majority opinion favours a total of three to five doses. Although, there was no statistical difference between a single pre-operative antibiotic dose versus a pre and post-operative protocol [20,42]. The drugs used vary but there is a necessity to cover the most frequent causes of infection such as Staphylococcus aureus [34] and the gram negative bacteria.…”