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Perioperative antibiotic use for spinal surgery procedures in US children's hospitals

Lisa M McLeod1, Ron Keren, Jeffrey Gerber

  • 1Department of General Pediatrics, Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA, USA. lisa.mcleod@me.com

Spine
|February 2, 2013
PubMed

Insights

Prophylactic antibiotic use for pediatric spinal fusion surgery varied significantly across hospitals and over time. Broad-spectrum antibiotic use was common, especially in high-risk patients, and increased over time.

Area of Science:

  • Pediatric Surgery
  • Infectious Disease
  • Pharmacology

Background:

  • Surgical site infections (SSIs) are a major complication of pediatric spinal surgery.
  • Increasing antimicrobial resistance necessitates a review of current prophylactic antibiotic practices.
  • Limited data exists on antibiotic selection for pediatric spinal fusion.

Purpose of the Study:

  • To analyze patterns of prophylactic antibiotic use in pediatric spinal fusion procedures.
  • To identify factors influencing antibiotic choice in US children's hospitals.
  • To describe trends in antibiotic selection over time.

Main Methods:

  • Retrospective cohort study utilizing the Pediatric Health Information System database.
  • Inclusion of pediatric patients (6 months-18 years) undergoing spinal fusion for adolescent idiopathic scoliosis or neuromuscular scoliosis.
  • Analysis of antibiotic orders on the operative day and associations with patient/surgery characteristics.

Main Results:

  • Significant variation in prophylactic antibiotic choice was observed across hospitals and longitudinally.
  • Broad-spectrum antibiotics were used in 37% of adolescent idiopathic scoliosis and 52% of neuromuscular scoliosis cases.
  • Use of vancomycin and broad gram-negative agents increased over the study period.

Conclusions:

  • Prophylactic antibiotic strategies for pediatric spinal fusion are inconsistent across institutions.
  • Broad-spectrum antibiotic use was associated with patient risk factors for SSIs.
  • Further research is needed to optimize prophylaxis and prevent SSIs in this population.
Abstract

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