Intraoperative antibiotic prophylaxis in clean spinal surgery: a retrospective analysis in a consecutive series of 973 cases.
BACKGROUND
Antibiotic prophylaxis in spine surgery is still a debated question, involving medical, ethical, economic, and legal issues. The aim of our retrospective study was to evaluate the safety and effectiveness of an intraoperative protocol of antibiotic prophylaxis.


METHODS
During a 3-year period, 973 patients were consecutively operated on for clean spinal operations. Twenty-three percent of the cases involved the cervical spine and 77% the thoraco-lumbar spine; about 90% of patients were operated on for degenerative diseases and the remaining for traumatic lesions or tumors. Patients undergoing operations shorter than 120 minutes received a single-dose of IV ampicillin 1000 mg and sulbactam 500 mg (AS) at induction of anesthesia. In procedures longer than 120 minutes and/or requiring prosthetic materials, an IV single-dose of teicoplanin 400 mg was also administered at the same time. A second intraoperative dose of AS and teicoplanin was administered in operations longer than 4 hours (240 minutes after the first one) and in procedures in which blood loss exceeded 1500 mL. Postoperative prophylaxis has never been performed.


RESULTS
The only side effect was a cutaneous rash in 7 cases (0.7%), without any consequence. A wound infection was detected in 9 cases (<1%), all successfully treated with surgical toilette and specific antibiotic treatment. A lumbar discitis was detected in 4 out of 657 microdiscectomies (0.6%).


CONCLUSIONS
Even if this study has the weakness of the retrospective character, our intraoperative antibiotic prophylaxis protocol proved to be safe and efficacious. We hope that these preliminary results will be confirmed by larger prospectic trials.
Mastronardi
Luciano
L
Division of Neurosurgery, Sandro Pertini Hospital, Roma, Italy.
Tatta
Carlo
C
D000667:Ampicillin / Q000008:administration & dosage / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D015331:Cohort Studies; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D006801:Humans; D007432:Intraoperative Period; D007710:Klebsiella Infections / Q000382:microbiology; D019635:Neurosurgical Procedures / Q000379:methods*; D011552:Pseudomonas Infections / Q000382:microbiology; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000453:epidemiology / Q000601:surgery*; D013203:Staphylococcal Infections / Q000382:microbiology; D013407:Sulbactam / Q000008:administration & dosage / Q000627:therapeutic use*; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D017334:Teicoplanin / Q000008:administration & dosage / Q000627:therapeutic use*
D000900:Anti-Bacterial Agents; D017334:Teicoplanin; D000667:Ampicillin; D013407:Sulbactam