SURGICAL SITE INFECTION IN LUMBAR SURGERIES, PRE AND POSTOPERATIVE ANTIBIOTICS AND LENGTH OF STAY: A CASE STUDY

Authors

  • Inayat Ullah Khan
  • Muhammad Burhanuddin Janjua
  • Shumaila Hasan
  • Shahid Shah

Abstract

Background: Postoperative wound infection also called as surgical site infection (SSI), is atrouble some complication of lumbar spine surgeries and they can be associated with seriousmorbidities, mortalities and increase resource utilization. With the improvement in diagnosticmodalities, proper surgical techniques, antibiotic therapy and postoperative care, infectiouscomplications can result in various compromises afterwards. The objective was to study therelation of surgical site infection in clean lumbar surgeries with the doses of antibiotics. ThisRetrospective study was conducted at Shifa International Hospital, from January 2006 to March2008. Methods: Hundred post operated cases of lumber disc prolapse, lumbar stenosis or bothstudied retrospectively by tracing their operated data from hospital record section for thedevelopment of surgical site infection (SSI). The patients were divided into three groupsdepending upon whether they received single, three or more than three doses of antibioticsrespectively. Complete data analyses and cross tabulation done with SPSS version 16. Result: Of100 cases, only 6% had superficial surgical site infection; only 1 case with co morbidity ofhypertension was detected. Twenty-one cases had single dose of antibiotic (Group-I), 59 cases had3 doses (Group-II) and 20 cases received multiple doses (Group-III). There was no infection inGroup-I. Only one patient in Group-II and 5 patients in Group-III developed superficial SSI.While 4 in Group-II, 3 in Group-III, and none of Group-I had >6 days length of stay (LOS).Conclusion The dose of antibiotic directly correlates with the surgical site infection in cleanlumbar surgeries. When compared with multiple doses of antibiotics a single preoperative shot ofantibiotic is equally effective for patients with SSI.Keywords: Lumber surgery, surgical site infection, wound infection

References

Chaudhary SB, Vives MJ, Basra SK, Reiter MF. Post operative

Spinal Wound Infections and Postprocediral Discitis. J Spinal

Cord Med 2007; 30:441–51.

Kanyama M, Hashimoto T, Shigenobu K, Oha F, Togawa D.

Effective prevention of surgical site infection using a Centers

for Disease Control and Prevention guideline-based

antimicrobial prophylaxis in lumbar spine surgery. J Neurosurg

Spine 2007;6:327–9.

Bassewitz HL, Fishgrund is, Herkowitz HN. Postoperative

spine infections. Semin Spine Surg 2000;12:203–11.

Abbey DM, Turner DM, Warson JS, Wirt TC, Scalley RD.

Treatment of post operative wound infection after spinal fusion

using instrumentation. J Spinal Disord 1995;8:278–83.

J Ayub Med Coll Abbottabad 2009;21(3)

http://www.ayubmed.edu.pk/JAMC/PAST/21-3/Inayat.pdf

Weinstein MA, McCabe JP, Cammisa FP Jr. Postoperative

spine infections: a review of 23191 consective index

procedures. J Spinal Disord 2000;13:422–6.

Oslen MA, Nepple JJ, Review KD, Lenke LG, Bridwell KH,

Mayfield J, Fraer VJ. Risk factors for the surgical site infection

following orthopaedic spinal operation. J Bone Joint Surg Am

;90:62–9.

Keller RB, Pappas AM. Infection after spinal fusion using

internal fixation instrumentation . Orthop Clin North Am

;3:99–111.

Levi AD, Dickman CA, Sonntag VK. Management of

postoperative infections after spinal instrumentation. J

Neurosurg 1997;86:975–80.

Zeidman SM, Ducker TB, Raycroft J. Trends and

complications in cervical spine surgery: 1989–1993. J Spinal

Discord 1997;10:523–6.

Horowitz NH, Curtin JA: Prophylactic antibiotics and wound

infections following Laminectomy for lumber disc herniation. J

Neurosurg 1975;43:727–31.

Rubinstein, Finder G, Amit P, Shaked I. Perioperative

prophylactic cephazolin in spinal surgery. A double-blind

placebo-controlled trial. J Bone Joint Surg Br 1994;76:99–102.

Guiboux JP, Canter JB, Small SD Zervos M, Herkowitz HN.

The effect of prophylactic antibiotics on iatrogenic

intervertebral disc infections: rabbit model. Spine

;20:685–8.

Swoboda SM, Merz C Kostuik J, Trentler B, Lipsett PA. Does

intraoperative blood loss affect antibiotic serum and tissue

concentrations. Arch Surg1996;131:1165–71.

Polly DW, Metter JJ, Bruckner R, Asplund A, van Dam BE.

The effect of blood loss on intraoperative serum cefazolin

levels in patients undergoing instrumented spinal fusion. A

prospective controlled study. Spine 2008;21:2363–7.

Dobzyniak M, Fischgrund JS, Hankins S. The effect of single

versus multiple antibiotic prophylaxis on the rate of wound

infection in lumbar disc surgery. Spine (Phila Pa 1976)

;28:E453–5.

Cruse PJ, Foord R. A five year prospective study of 203649

surgical wounds. Arch Surg 1973;107:206–10.

Dubousset J, Shufflebarger H, Wenger D. Late infection with

CD instrumentation. Orthop Trans 1994;18:121.

Viola Rw, King HA, Adler SM, Wilsonn CB. Delayed

infection after elective spinal instrumentation and fusion. A

retrospective analysis of eight cases. Spine 1997;22:2444–51.

Sponseller PD, LaPorte DM, Hungerford MW, Eck K,

Bridwell KW, Lente LG. Deep wound infection after

neuromuscular scoliosis surgery. Spine 2007;25:2461–6.

Heggeness MH, Esses SI, Errico T, Yuan HA. Late infection os

spinal instrumentation by hematogenous seeding. Spine

;18:492–6.

Published

2009-09-01