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


CONCLUSIONS
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.
Hellbusch
Leslie C
LC
Section of Neurosurgery, Department of Surgery, Nebraska Medical Center, Omaha, Nebraska 68198, USA. lhellbusch@msn.com
Helzer-Julin
Michele
M
Doran
Stephen E
SE
Leibrock
Lyal G
LG
Long
Douglas J
DJ
Puccioni
Mark J
MJ
Thorell
William E
WE
Treves
John S
JS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D002511:Cephalosporins / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011446:Prospective Studies; D013122:Spinal Diseases / Q000209:etiology / Q000473:pathology / Q000601:surgery; D013123:Spinal Fusion / Q000295:instrumentation; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D055815:Young Adult
D000900:Anti-Bacterial Agents; D002511:Cephalosporins