Single-dose vs multiple-dose antibiotic prophylaxis in instrumented lumbar fusion--a prospective study.

Autor: Hellbusch LC; Section of Neurosurgery, Department of Surgery, Nebraska Medical Center, Omaha, Nebraska 68198, USA. lhellbusch@msn.com, Helzer-Julin M, Doran SE, Leibrock LG, Long DJ, Puccioni MJ, Thorell WE, Treves JS
Jazyk: angličtina
Zdroj: Surgical neurology [Surg Neurol] 2008 Dec; Vol. 70 (6), pp. 622-7; discussion 627. Date of Electronic Publication: 2008 Jan 18.
DOI: 10.1016/j.surneu.2007.08.017
Abstrakt: Background: This prospective investigation was designed to determine if the postoperative infection rate in instrumented lumbar spinal fusion is affected by postoperative antibiotic use.
Methods: Two hundred sixty-nine patients were randomized into either a preoperative only protocol or preoperative with an extended postoperative antibiotic protocol. The preoperative only protocol received a single dose of cefazolin IV. The extended postoperative antibiotic protocol received the same preoperative dose plus postoperative cefazolin IV every 8 hours for 3 days followed by oral cephalexin every 6 hours for 7 days. Because of untoward drug reaction or deviation from the antibiotic protocol, 36 of the 269 patients were eliminated from the study. Therefore, 233 patients completed the entire study.
Results: There was no significant difference in infection rates between the 2 antibiotic protocols. The postoperative infection rates were 4.3% for the preoperative only protocol and 1.7% for the preoperative with extended antibiotic protocol. The overall postoperative infection rate was 3%. However, 5 variables of blood transfusion, electrophysiologic monitoring, increased height, increased weight, and increased body mass index appeared to demonstrate a trend toward increase in infection rate. Increased tobacco use trended toward a lower infection rate.
Conclusion: Statistical significance was not proven in this prospective study comparing single-dose preoperative antibiotic protocol vs preoperative with an extended postoperative antibiotic protocol. A larger study of 1400 patients would possibly provide more statistically significant information.
Databáze: MEDLINE
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