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Effect of Cyanoacrylate Microbial Sealant on Intraoperative Bacterial Contamination in Spine Surgery: A Prospective
Kazuyoshi Kobayashi1, Koji Sato1, Yoshinori Morita1
1Department of Orthopaedic Surgery, Japan Red Cross Aichi Medical Center, Nagoya Daini Hospital, Nagoya, Japan.
Introduction:
Surgical site infection (SSI) remains a significant complication in spinal surgery, particularly in instrumented procedures. While modern skin antisepsis and antibiotic prophylaxis reduce infection risk, microbial ingress from residual skin flora persists. Cyanoacrylate-based microbial sealants have shown promise in other surgical fields, but their efficacy in spinal surgery remains unclear. This study aimed to evaluate whether a cyanoacrylate microbial sealant could reduce postoperative drain colonization, an established surrogate marker for early bacterial contamination.
Methods:
A prospective study was conducted on 160 consecutive spinal surgeries at a single tertiary spine center. Patients were divided into two groups: 80 received standard skin preparation alone (control), and 80 received additional application of a microbial sealant (Guardiseal) after skin preparation. Drain-tip cultures were obtained upon removal (average postoperative day 2) and analyzed microbiologically. The primary outcome was the rate of positive drain-tip culture (≥20 colony-forming units); secondary outcomes included SSI incidence within 90 days. Standard perioperative protocols were maintained across both groups.
Results:
Positive drain-tip cultures occurred in 8 of 160 cases (5.0%), with a significantly lower rate in the sealant group than in the control group (1 of 80 [1.3%] vs. 7 of 80 [8.8%], p=0.029). SSI was confirmed in two patients (one superficial, one deep), both microbiologically concordant with drain-tip cultures. The sensitivity and negative predictive value of drain-tip cultures for SSI were 100% in both groups; the positive predictive value was 100% in the sealant group and 29% in the control group. No adverse effects or workflow issues were observed with sealant use.
Conclusions:
Use of a cyanoacrylate microbial sealant in spinal surgery significantly reduced postoperative drain colonization without adverse effects. While SSI rates remained unchanged, the microbiological benefits suggest that sealants may serve as a valuable adjunct to infection prevention strategies. Further large-scale, randomized studies are warranted.
Insights
A cyanoacrylate microbial sealant significantly reduced drain colonization in spinal surgery patients. This innovative approach shows promise for preventing early bacterial contamination and surgical site infections (SSIs).
Area of Science:
- Spinal Surgery
- Infectious Disease Control
- Biomaterials
Background:
- Surgical site infection (SSI) is a major complication in spinal surgery, despite current preventative measures.
- Microbial ingress from skin flora remains a challenge, even with antisepsis and antibiotics.
- Cyanoacrylate sealants show potential but require specific evaluation in spinal procedures.
Purpose of the Study:
- To assess the efficacy of a cyanoacrylate microbial sealant in reducing postoperative drain colonization in spinal surgery.
- To evaluate drain-tip cultures as a surrogate marker for early bacterial contamination.
- To determine the impact of the sealant on SSI incidence and associated microbiology.
Main Methods:
- Prospective study of 160 spinal surgery patients divided into control (standard care) and sealant groups.
- Application of a cyanoacrylate microbial sealant (Guardiseal) after skin preparation in the intervention group.
- Collection and microbiological analysis of drain-tip cultures on postoperative day 2.
Main Results:
- Significantly lower positive drain-tip culture rates in the sealant group (1.3%) compared to the control group (8.8%), p=0.029.
- 100% sensitivity and negative predictive value of drain-tip cultures for SSI in both groups.
- No adverse effects or workflow disruptions were associated with the microbial sealant.
Conclusions:
- Cyanoacrylate microbial sealant effectively reduces postoperative drain colonization in spinal surgery.
- The sealant shows potential as an adjunct to infection prevention strategies, improving microbiological outcomes.
- Further large-scale randomized trials are recommended to confirm SSI rate reduction.
