Antibiotic Prophylaxis in Instrumented Lumbar Spine Surgery: Cefazolin Outperforms Clindamycin Regardless of Duration

Area of Science:

• Orthopedic Surgery
• Infectious Disease Prevention
• Pharmacology

Background:

• Surgical site infections (SSIs) are a major concern following instrumented lumbar spine surgery.
• Effective prevention relies on appropriate prophylactic antibiotic selection and duration.
• Optimizing antibiotic strategies is crucial for patient outcomes and reducing healthcare burdens.

Purpose of the Study:

• To evaluate the efficacy of cefazolin versus clindamycin for SSI prevention in instrumented lumbar spine surgery.
• To assess the impact of antibiotic prophylaxis duration (single dose vs. 72 hours) on SSI rates.
• To identify risk factors associated with SSI development in this patient population.

Main Methods:

• Retrospective analysis of 915 patients undergoing instrumented lumbar spine surgery (2016-2024).
• Comparison of SSI incidence based on antibiotic type (cefazolin vs. clindamycin) and duration.
• Statistical analysis using Fisher and Welch tests to compare infection rates.

Main Results:

• Overall SSI incidence was 11.7%.
• Cefazolin demonstrated a significantly lower infection rate compared to clindamycin (OR = 0.45; p = 0.0206).
• Multi-segment surgeries were associated with a significantly higher risk of SSI (p = 0.0005).

Conclusions:

• Cefazolin is a superior prophylactic antibiotic for instrumented lumbar spine surgery compared to clindamycin.
• Short-term, adequate-dose cefazolin prophylaxis is recommended, balancing efficacy with reduced antimicrobial resistance and side effects.
• Antibiotic duration showed less influence on SSI risk than the choice of antibiotic.