Antibiotic prophylaxis in spine surgery: a comparison of single-dose and 72-hour protocols

Despite the general consensus on the use of single-dose antimicrobial prophylaxis (AMP) in instrumented spine surgery, evidence supporting this approach is not robust.

To compare the efficacies of single-dose and 72 h AMP protocols for the prevention of surgical site infection (SSI) in instrumented spine surgery (ISS) in a before-and-after study.

Prospective non-randomized cohort study on 5208 patients who underwent spine surgery in one neurosurgical department between 2003 and 2014. Two protocols of AMP were compared in ISS: a single-dose protocol from 2003 to 2008, and a 72 h protocol from 2009 to 2014. Patients undergoing non-instrumented spine surgery (NSS) received single-dose prophylaxis throughout both periods. The outcome measure was the incidence of SSI.

For ISS, the SSI incidences were 5.3% for the single-dose protocol and 2.2% for the 72 h protocol (P < 0.01). For NSS, the SSI incidence was 0.8% between 2003 and 2008 and 1.2% between 2009 and 2014 (P = 0.054). Multiple correspondence analysis showed that in surgeries with an implant a one-dose prophylaxis carries a 7.1% risk of SSI; patients who received 72 h prophylaxis had a lower (3.6%) risk of SSI.

Analysis of individual categories of data suggests that 72 h prophylaxis was the most important factor for minimizing the risk of wound infection in our study group.