Postdischarge antibiotic use for prophylaxis following spinal fusion.

in Infection control and hospital epidemiology by David K Warren, Katelin B Nickel, Jennifer H Han, Pam Tolomeo, Christopher J Hostler, Katherine Foy, Ian R Banks, Victoria J Fraser, Margaret A Olsen,

TLDR

  • The study looked at why some people get antibiotics after having spinal surgery, even though they're supposed to stop taking them after a certain amount of time. The study found that certain factors, like having a serious illness or being very overweight, were more likely to make people get antibiotics after surgery. The study also found that it's important for doctors to carefully consider whether or not to give antibiotics after surgery, because they can have side effects and may not always be necessary.

Abstract

Despite recommendations to discontinue prophylactic antibiotics after incision closure or <24 hours after surgery, prophylactic antibiotics are continued after discharge by some clinicians. The objective of this study was to determine the prevalence and factors associated with postdischarge prophylactic antibiotic use after spinal fusion. Multicenter retrospective cohort study. This study included patients aged ≥18 years undergoing spinal fusion or refusion between July 2011 and June 2015 at 3 sites. Patients with an infection during the surgical admission were excluded. Prophylactic antibiotics were identified at discharge. Factors associated with postdischarge prophylactic antibiotic use were identified using hierarchical generalized linear models. In total, 8,652 spinal fusion admissions were included. Antibiotics were prescribed at discharge in 289 admissions (3.3%). The most commonly prescribed antibiotics were trimethoprim/sulfamethoxazole (22.1%), cephalexin (18.8%), and ciprofloxacin (17.1%). Adjusted for study site, significant factors associated with prophylactic discharge antibiotics included American Society of Anesthesiologists (ASA) class ≥3 (odds ratio [OR], 1.31; 95% CI, 1.00-1.70), lymphoma (OR, 2.57; 95% CI, 1.11-5.98), solid tumor (OR, 3.63; 95% CI, 1.62-8.14), morbid obesity (OR, 1.64; 95% CI, 1.09-2.47), paralysis (OR, 2.38; 95% CI, 1.30-4.37), hematoma/seroma (OR, 2.93; 95% CI, 1.17-7.33), thoracic surgery (OR, 1.39; 95% CI, 1.01-1.93), longer length of stay, and intraoperative antibiotics. Postdischarge prophylactic antibiotics were uncommon after spinal fusion. Patient and perioperative factors were associated with continuation of prophylactic antibiotics after hospital discharge.

Overview

  • The study aimed to determine the prevalence and factors associated with postdischarge prophylactic antibiotic use after spinal fusion.
  • The study used a multicenter retrospective cohort design and included patients aged ≥18 years undergoing spinal fusion or refusion between July 2011 and June 2015 at 3 sites.
  • The primary objective of the study was to identify factors that may contribute to the continuation of prophylactic antibiotics after hospital discharge.

Comparative Analysis & Findings

  • The study found that antibiotics were prescribed at discharge in 3.3% of spinal fusion admissions.
  • The most commonly prescribed antibiotics were trimethoprim/sulfamethoxazole, cephalexin, and ciprofloxacin.
  • Factors associated with prophylactic discharge antibiotics included ASA class ≥3, lymphoma, solid tumor, morbid obesity, paralysis, hematoma/seroma, thoracic surgery, longer length of stay, and intraoperative antibiotics.

Implications and Future Directions

  • The study highlights the need for clinicians to carefully consider the risks and benefits of continuing prophylactic antibiotics after hospital discharge.
  • Future research should focus on developing more targeted and personalized antibiotic regimens based on individual patient characteristics and surgical factors.
  • Clinical guidelines should be updated to reflect the findings of this study and provide clear recommendations for the use of prophylactic antibiotics after spinal fusion.
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