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Association between duration of antimicrobial prophylaxis and postoperative outcomes after lumbar spine surgery

Mary W Porter1, William Burdi1, Jonathan D Casavant1

  • 1Pharmacy Services, VA Puget Sound Health Care System, Seattle, Washington.

Infection Control and Hospital Epidemiology
|February 15, 2022
PubMed
Abstract

Insights

Longer antimicrobial prophylaxis (AMP) courses in spine surgery increase risks for infection and reoperation. Adherence to recommended AMP duration is low, highlighting a gap for surgeons and stewardship programs.

Area of Science:

  • Infectious Diseases
  • Surgical Outcomes
  • Antimicrobial Stewardship

Background:

  • Antimicrobial prophylaxis (AMP) is standard for preventing surgical site infections (SSI) in lumbar spine surgery.
  • Current guidelines recommend specific durations for AMP, but adherence and its impact on outcomes are not fully understood.

Purpose of the Study:

  • To examine the association between AMP duration and outcomes like SSI, acute kidney injury (AKI), Clostridioides difficile infection (CDI), prolonged hospitalization, and reoperation.
  • To assess adherence to current AMP guidelines in lumbar spine surgery.

Main Methods:

  • A survey of 6,198 patients undergoing lumbar spine surgery for noninfectious indications across 137 VHA centers (2016-2020).
  • Univariate and multivariate logistic regression analyses were used to determine associations between AMP characteristics and patient outcomes.

Main Results:

  • Only 18.7% of patients received the recommended AMP duration.
  • Longer AMP courses (≥3 days) were linked to increased odds of prolonged hospitalization and reoperation.
  • Multiple prophylactic antimicrobials were associated with higher odds of CDI and reoperation.

Conclusions:

  • Extended AMP use in lumbar spine surgery is associated with increased risks of CDI, prolonged hospitalization, and reoperation.
  • Low adherence to recommended AMP durations suggests a significant evidence-to-practice gap requiring attention from spine surgeons and antimicrobial stewardship programs.

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