The Spine Journal
Volume 9, Issue 2 , Pages 142-146 , February 2009

Antibiotic prophylaxis in spine surgery: an evidence-based clinical guideline for the use of prophylactic antibiotics in spine surgery

  • William C. Watters III, MD

      Affiliations

    • Bone & Joint Clinic, Ortho Spine, 6624 Fannin Street, Suite 2600, Houston, TX 77030-2312, USA
    • Corresponding Author InformationCorresponding author. Bone & Joint Clinic, Ortho Spine, 6624 Fannin Street, Suite 2600, Houston, TX 77030-2312, USA. Tel.: (713) 790-1818 ext 120; home: (713) 965-0961; fax: (713) 790-7530.
    • ,
  • Jamie Baisden, MD

      Affiliations

    • Medical College of Wisconsin, Department of Neurosurgery, 9200 W. Wisconsin Avenue, Milwaukee, WI 53226-3522, USA
    • ,
  • Christopher M. Bono, MD

      Affiliations

    • Brigham & Women's Hospital, Department of Ortho. Surgery, 75 Francis Street, Boston MA 02115-6110, USA
    • ,
  • Michael H. Heggeness, MD, PhD

      Affiliations

    • Baylor College of Medicine, Orthopaedic Department, 1709 Dryden Road, Ste. 1230, Houston, TX 77030-2400, USA
    • ,
  • Daniel K. Resnick, MD

      Affiliations

    • University of Wisconsin Medical School, 600 Highland, Department Neurosurgery, K4/834 Clinical Science Center, Madison, WI 53792-0001, USA
    • ,
  • William O. Shaffer, MD

      Affiliations

    • University of Kentucky, 740 S. Limestone Street, Kentucky Clinic K-416, Lexington, KY 40536-0001, USA
    • ,
  • John F. Toton, MD

      Affiliations

    • 1310 Prentice Drive, Ste. G, Healdsburg, CA 95448-5005, USA

Received 12 December 2007 ,Accepted 19 May 2008.

References 

  1. Crossing the quality chasm: a new health system for the 21st Century. Washington, DC: Institute of Medicine; 2001;
  2. Heffner JE. Does evidence-based medicine help the development of clinical practice guidelines?. Chest. 1988;113(3 Suppl):172S–178S
  3. Barker FG. Efficacy of prophylactic antibiotic therapy in spinal surgery: a meta-analysis. Neurosurgery. 2002;51:391–400discussion 400–1
  4. Christodoulou AG, Givissis P, Symeonidis PD, Karataglis D, Pournaras J. Reduction of postoperative spinal infections based on an etiologic protocol. Clin Orthop Relat Res. 2006;444:107–113
  5. Fang A, Hu SS, Endres N, Bradford DS. Risk factors for infection after spinal surgery. Spine. 2005;30:1460–1465
  6. Holloway KL, Smith KW, Wilberger JE, Jemsek JG, Giguere GC, Collins JJ. Antibiotic prophylaxis during clean neurosurgery: a large, multicenter study using cefuroxime. Clin Ther. 1996;18:84–94
  7. Mastronardi L, Tatta C. Intraoperative antibiotic prophylaxis in clean spinal surgery: a retrospective analysis in a consecutive series of 973 cases. Surg Neurol. 2004;61:129–135discussion 135
  8. Pavel A, Smith RL, Ballard A, Larson IJ. Prophylactic antibiotics in elective orthopedic surgery: a prospective study of 1591 cases. South Med J. 1977;Suppl 1:50–55
  9. Perry JW, Montgomerie JZ, Swank S, Gilmore DS, Maeder K. Wound infections following spinal fusion with posterior segmental spinal instrumentation. Clin Infect Dis. 1997;24:558–561
  10. Riley LH. Prophylactic antibiotics for spine surgery: description of a regimen and its rationale. J South Orthop Assoc. 1998;7:212–217
  11. Rubinstein E, Findler G, Amit P, Shaked I. Perioperative prophylactic cephazolin in spinal surgery. A double-blind placebo-controlled trial. J Bone Joint Surg Br. 1994;76:99–102
  12. Savitz SI, Lee LV, Goldstein HB. The risk of wound infection in lumbar disk surgery. Mt Sinai J Med. 1991;58:179–182
  13. Wimmer C, Nogler M, Frischut B. Influence of antibiotics on infection in spinal surgery: a prospective study of 110 patients. J Spinal Disord. 1998;11:498–500
  14. Luer MS, Hatton J. Appropriateness of antibiotic selection and use in laminectomy and microdiskectomy. Am J Hosp Pharm. 1993;50:667–670
  15. Piotrowski WP, Krombholz MA, Muhl B. Spondylodiscitis after lumbar disk surgery. Neurosurg Rev. 1994;17:189–193
  16. Rohde V, Meyer B, Schaller C, Hassler WE. Spondylodiscitis after lumbar discectomy. Incidence and a proposal for prophylaxis. Spine. 1998;23:615–620
  17. Beiner JM, Grauer J, Kwon BK, Vaccaro AR. Postoperative wound infections of the spine. Neurosurg Focus. 2003;15:E14
  18. Rechtine GR, Bono PL, Cahill D, Bolesta MJ, Chrin AM. Postoperative wound infection after instrumentation of thoracic and lumbar fractures. J Orthop Trauma. 2001;15:566–569
  19. Pons VG, Denlinger SL, Guglielmo BJ, et al. Comment; ceftizoxime versus vancomycin and gentamicin in neurosurgical prophylaxis. Neurosurgery. 1993;33:537
  20. Kanafani ZA, Dakdouki GK, El-Dbouni O, Bawwab T, Kanj SS. Surgical site infections following spinal surgery at a tertiary care center in Lebanon: incidence, microbiology, and risk factors. Scand J Infect Dis. 2006;38:589–592
  21. Labbe AC, Demers AM, Rodrigues R, Arlet V, Tanguay K, Moore DL. Surgical-site infection following spinal fusion: a case-control study in a children's hospital. Infect Control Hosp Epidemiol. 2003;24:591–595
  22. Sponseller PD, LaPorte DM, Hungerford MW, Eck K, Bridwell KH, Lenke LG. Deep wound infections after neuromuscular scoliosis surgery: a multicenter study of risk factors and treatment outcomes. Spine. 2000;25:2461–2466
  23. Dobzyniak MA, Fischgrund JS, Hankins S, Herkowitz HN. Single versus multiple dose antibiotic prophylaxis in lumbar disc surgery. Spine. 2003;28:E453–E455
  24. Payne DH, Fischgrund JS, Herkowitz HN, Barry RL, Kurz LT, Montgomery DM. Efficacy of closed wound suction drainage after single-level lumbar laminectomy. J Spinal Disord. 1996;9:401–403
  25. Olsen MA, Mayfield J, Lauryssen C, et al. Risk factors for surgical site infection in spinal surgery. J Neurosurg. 2003;98(2 Suppl):149–155
  26. Wimmer C, Gluch H, Franzreb M, Ogon M. Predisposing factors for infection in spine surgery: a survey of 850 spinal procedures. J Spinal Disord. 1998;11:124–128

 FDA device/drug status: not applicable. Nothing of value received from a commercial party.

PII: S1529-9430(08)00203-9

doi: 10.1016/j.spinee.2008.05.008

The Spine Journal
Volume 9, Issue 2 , Pages 142-146 , February 2009

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