Perioperative antibiotic use for spinal surgery procedures in US children's hospitals.
METHODS
Retrospective cohort study using the Pediatric Health Information System database.


OBJECTIVE
To describe longitudinal patterns of prophylactic antibiotic use and determinants of antibiotic choice for spinal fusion surgical procedures performed at US children's hospitals.


BACKGROUND
Surgical site infections (SSIs) account for a significant proportion of post-spinal surgery complications, particularly among children with complex conditions such as neuromuscular disease. Antimicrobial prophylaxis with intravenous cefazolin or cefuroxime has been a standard practice, but postoperative infections caused by organisms resistant to these antibiotics are increasing in prevalence. Studies describing the choice of antibiotic prophylaxis for pediatric spinal surgery are lacking.


METHODS
We included children 6 months to 18 years of age discharged from 37 US children's hospitals between January 1, 2006, and June 30, 2009, with (1) an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure code indicating a spinal fusion and (2) combinations of diagnosis codes indicating adolescent idiopathic scoliosis (AIS) (n = 5617) or neuromuscular scoliosis (NMS) (n = 3633). After identifying antibiotics ordered on the operative day, we described variation in broad-spectrum antibiotic use over time and measured associations between patient/surgery characteristics and antibiotic choice.


RESULTS
Prophylactic antibiotic choice varied across hospitals and over time. Broad-spectrum antibiotics were used in 37% of AIS and 52% of NMS operations. Seven (19%) hospitals used broad-spectrum coverage for more 80% of all cases. For NMS procedures, broad-spectrum antibiotic use was associated with patient characteristics known to be associated with high SSI risk. Use of vancomycin and broad gram-negative agents increased over time.


CONCLUSIONS
Broad-spectrum antimicrobial prophylaxis varied across hospitals and was often associated with known risk factors for SSI. These results highlight the need for future studies comparing the effectiveness of various prophylaxis strategies, particularly in high-risk subgroups. This research can inform the development of best practice for SSI prevention in spinal fusion procedures.
Department of General Pediatrics, Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA, USA. lisa.mcleod@me.com
Lisa M
LM
McLeod
Ron
R
Keren
Jeffrey
J
Gerber
Benjamin
B
French
Lihai
L
Song
Norma R
NR
Sampson
John
J
Flynn
John P
JP
Dormans
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000145:classification / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data* / Q000639:trends; D002437:Cefazolin / Q000008:administration & dosage / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016208:Databases, Factual; D004198:Disease Susceptibility; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D009468:Neuromuscular Diseases / Q000150:complications; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012306:Risk; D012600:Scoliosis / Q000150:complications / Q000209:etiology / Q000601:surgery; D016135:Spinal Dysraphism / Q000150:complications; D013123:Spinal Fusion / Q000706:statistics & numerical data*; D013530:Surgical Wound Infection / Q000188:drug therapy* / Q000453:epidemiology; D014481:United States; D014640:Vancomycin / Q000008:administration & dosage / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D014640:Vancomycin; D002437:Cefazolin