The Role of Prophylactic Antibiotics in Spinal Instrumentation

Guiboux, Jean Paul; Ahlgren, Bradley; Patti, James E.; Bernhard, Matthew; Zervos, Marcus J.; Herkowitz, Harry N.

doi:10.1097/00007632-199803150-00002

Cited by 16 publications

(25 citation statements)

References 10 publications

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“…In 1998, Guiboux et al designed one of the first animal models of instrumented spine infection . This model was utilized to investigate the effects of both instrumentation and perioperative antibiotics on infection following spine surgery.…”

Section: Discussionmentioning

confidence: 99%

“…In 1998, Guiboux et al designed one of the first animal models of instrumented spine infection. 15 This model was utilized to investigate the effects of both instrumentation and perioperative antibiotics on infection following spine surgery. Since that time numerous other models have been developed, including a rat model by Ofluoglu et al and rabbit model by Poelstra et al 14,24 While each model presented advantages, all required invasive, ex vivo tissue analysis to evaluate results.…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, these therapies often do not progress beyond the hypothetical, as there are no efficient, accurate, and available animal models to assess safety and efficacy. Current animal models of spine infection require large numbers of animals, as all data points are invasive (colony counting, histology, culture) and require euthanasia of the animal . These models are therefore, extremely expensive and inefficient, providing a single data point per animal.…”

mentioning

confidence: 99%

“…Current animal models of spine infection require large numbers of animals, as all data points are invasive (colony counting, histology, culture) and require euthanasia of the animal. [14][15][16] These models are therefore, extremely expensive and inefficient, providing a single data point per animal.…”

mentioning

confidence: 99%

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Novel in vivo mouse model of implant related spine infection

Dworsky

Hegde

Loftin

et al. 2016

Journal Orthopaedic Research

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Post-operative spine infections are a challenge, as hardware must often be retained to prevent destabilization of the spine, and bacteria form biofilm on implants, rendering them inaccessible to antibiotic therapy, and immune cells. A model of posterior-approach spinal surgery was created in which a stainless steel k-wire was transfixed into the L4 spinous process of 12-week-old C57BL/six mice. Mice were then randomized to receive either one of three concentrations (1 × 102, 1 × 103, and 1 × 104 colony forming units (CFU)) of a bioluminescent strain of Staphylococcus aureus or normal saline at surgery. The mice were then longitudinally imaged for bacterial bioluminescence to quantify infection. The 1 × 102 CFU group had a decrease in signal down to control levels by POD 25, while the 1 × 103 and 1 × 104 CFU groups maintained a 10-fold higher signal through POD 35. Bacteria were then harvested from the pin and surrounding tissue for confirmatory CFU counts. All mice in the 1 × 104 CFU group experienced wound breakdown, while no mice in the other groups had this complication. Once an optimal bacterial concentration was determined, mice expressing enhanced green fluorescent protein in their myeloid cells (Lys-EGFP) were utilized to contemporaneously quantify bacterial burden, and immune response. Neutrophil fluorescence peaked for both groups on POD 3, and then declined. The infected group continued to have a response above the control group through POD 35. This study, establishes a noninvasive in vivo mouse model of spine implant infection that can quantify bacterial burden and host inflammation longitudinally in real time without requiring animal sacrifice.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Novel in vivo mouse model of implant related spine infection

Dworsky

Hegde

Loftin

et al. 2016

Journal Orthopaedic Research

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“…Guiboux et al combined previously described rabbit spine fusion, instrumentation, and intervertebral disk infection models to create a postoperative infection model (13). Twenty rabbits were inoculated with S. aureus intraoperatively and were split into four groups based on whether or not they received instrumentation and prophylactic perioperative antibiotics (cefazolin 30 mg/kg 5 min before incision or after surgery).…”

Section: Established Animal Models Of Spine Infectionmentioning

confidence: 99%

Current Animal Models of Postoperative Spine Infection and Potential Future Advances

et al. 2015

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Implant related infection following spine surgery is a devastating complication for patients and can potentially lead to significant neurological compromise, disability, morbidity, and even mortality. This paper provides an overview of the existing animal models of postoperative spine infection and highlights the strengths and weaknesses of each model. In addition, there is discussion regarding potential modifications to these animal models to better evaluate preventative and treatment strategies for this challenging complication. Current models are effective in simulating surgical procedures but fail to evaluate infection longitudinally using multiple techniques. Potential future modifications to these models include using advanced imaging technologies to evaluate infection, use of bioluminescent bacterial species, and testing of novel treatment strategies against multiple bacterial strains. There is potential to establish a postoperative spine infection model using smaller animals, such as mice, as these would be a more cost-effective screening tool for potential therapeutic interventions.

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Prevention of infection with tobramycin-containing bone cement or systemic cefazolin in an animal model

Nijhof

Stallmann

Charles

et al. 2000

J. Biomed. Mater. Res.

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We investigated in an animal model the efficacy of tobramycin-containing bone cement and systemic cefazolin for infection prophylaxis. In 18 female rabbits, the femoral cavity was inoculated with Staphylococcus aureus before injection of bone cement. The first group of six rabbits received tobramycin-containing Simplex-P bone cement. Two other groups of six rabbits received plain Simplex-P bone cement. Preoperatively, in one of the two latter groups cefazolin was administered intravenously. The other group served as untreated controls. The rabbits were monitored for clinical signs of infection. At 7 days' follow-up, the femora were harvested and cultures from the bone adjacent to the cement plug were quantified. Cultures from the rabbits which received antibiotic prophylaxis (either cefazolin systemically or tobramycin-containing bone cement) were all negative. In contrast, all rabbits in the untreated control group had positive cultures. These rabbits also had other signs of infection such as an elevated erythrocyte sedimentation rate and loss of body weight. Culture results were confirmed by the absence of bacterial DNA in the polymerase chain reaction hybridization assay. In conclusion, we found that both tobramycin-containing bone cement and systemic cefazolin are effective in preventing implant bed infection in rabbits up to 7 days after contamination with S. aureus.

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The Role of Prophylactic Antibiotics in Spinal Instrumentation

Abstract: This model was valid and reproducible for the study of spinal instrumentation and infection. In addition, the data support the efficacy and use of prophylactic intravenous antibiotics in preventing infection in spinal instrumentation and fusion surgery.

Cited by 16 publications

References 10 publications

Novel in vivo mouse model of implant related spine infection

Novel in vivo mouse model of implant related spine infection

Current Animal Models of Postoperative Spine Infection and Potential Future Advances

Prevention of infection with tobramycin-containing bone cement or systemic cefazolin in an animal model

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