Last updated March 14, 2022

Antibiotic Prophylaxis In Spine Surgery

Recommendations

Efficacy

Preoperative prophylactic antibiotics are suggested to decrease infection rates in patients undergoing spine surgery. (B: Suggested)
317978
For a typical uncomplicated lumbar laminotomy and discectomy, a single preoperative dose of antibiotics is suggested to decrease the risk of infection and/or discitis. (B: Suggested)
317978
Prophylactic antibiotics are suggested to decrease the rate of spinal infections after uninstrumented lumbar spinal surgery. (B: Suggested)
317978
Prophylactic antibiotics may be considered to decrease the rate of infections after instrumented spine fusion. (C: Optional)
317978
Despite appropriate prophylaxis, the rate of surgical site infections in spine surgery is 0.7% to 10%. The expected rate for patients without comorbidities ranges from 0.7% to 4.3% and for patients with comorbidities ranges from 2.0% to 10%. Current best practice with antibiotic protocols has failed to eliminate (reach an infection rate of 0.0%) surgical site infections.
(Work Group Consensus Statement)
317978
Despite appropriate prophylaxis, diabetes carries an increased infection rate compared with nondiabetic patients. (, Level III)
317978
There is insufficient evidence to make a statement regarding the impact of obesity on the rate of surgical site infection in prophylaxed patients. (Insufficient)
317978

Protocol

Preoperative antibiotic prophylaxis is suggested to decrease infection rates in patients undergoing spine surgery. In typical uncomplicated spinal procedures, the superiority of one agent, dose, or route of administration over any other has not been clearly demonstrated. When determining the appropriate drug choice, the patient’s risk factors, allergies, length and complexity of the procedure, and issues of antibiotic resistance should be considered. (B: Suggested)
317978
In typical uncomplicated spinal procedures, a single dose of preoperative prophylactic antibiotics with intraoperative redosing as needed is suggested. (B: Suggested)
317978
In patients with comorbidities or for those undergoing complicated spine surgery, alternative prophylactic regimens, including redosing, gram-negative coverage, or the addition of intrawound application of vancomycin or gentamicin, are suggested to decrease the incidence of surgical site infections compared with standard prophylaxis regimens. (, )
(Work Group Consensus Statement)
317978
Preoperative antibiotic prophylaxis is suggested to decrease infection rates in patients undergoing spine surgery without spinal implants. In these typical uncomplicated spinal procedures, the superiority of one agent, dose, or route of administration over any other has not been clearly demonstrated. When determining the appropriate drug choice, the patient’s risk factors, allergies, length and complexity of the procedure, and issues of antibiotic resistance should be considered. (B: Suggested)
317978
In typical uncomplicated open spine surgery without spinal implants, a single dose of preoperative prophylactic antibiotics with intraoperative redosing as needed is suggested. (B: Suggested)
317978
Preoperative antibiotic prophylaxis is suggested to decrease infection rates in patients undergoing spine surgery with spinal implants. In these complex spinal procedures, the superiority of one agent, dose, or route of administration over any other has not been clearly demonstrated. When determining the appropriate drug choice, the patient’s risk factors, allergies, length and complexity of the procedure, and issues of antibiotic resistance should be considered. (B: Suggested)
317978
In patients with risk factors for polymicrobial infection, appropriate broad-spectrum antibiotics are suggested to decrease the risk of infection when instrumented fusion is performed. (, )
(Work Group Consensus Statement)
317978
Simple uncomplicated spine surgery (without instrumentation or comorbidities): one single preoperative dose of antibiotic of choice with intraoperative redosing as needed. (, )
(Work Group Consensus Statement)
317978
Instrumented spine surgery, prolonged procedures, comorbidities (eg, diabetes, neuromuscular disease, cord injury, or general spine trauma): one single preoperative dose of antibiotic of choice plus consideration of additional gram-negative coverage and/or the application of intrawound vancomycin or gentamicin. (, )
(Work Group Consensus Statement)
317978

Redosing

Intraoperative redosing within 3 to 4 hours may be considered to maintain therapeutic antibiotic levels throughout the procedure. The superiority of one drug has not been demonstrated in the literature. When determining the appropriate drug choice, the patient’s risk factors, allergies, length and complexity of the procedure, and issues of antibiotic resistance should be considered. (, )
(Work Group Consensus Statement)
317978

Discontinuation

For typical uncomplicated cases, a single dose of preoperative prophylactic antibiotics with intraoperative redosing as needed is suggested to decrease the risk of surgical site infection. (B: Suggested)
317978
Prolonged postoperative regimens may be considered in complex situations (ie, trauma, cord injury, neuromuscular disease, diabetes, or other comorbidities). Comorbidities and complex situations reviewed in the literature include obesity, diabetes, neurologic deficits, incontinence, preoperative serum glucose level of O125 mg/dL or a postoperative serum glucose level ofO200 mg/dL, trauma, prolonged multilevel instrumented surgery, and other comorbidities. (C: Optional)
317978

Wound drains

A comprehensive review of the literature did not yield evidence to address the question related to the effect on postoperative infection rates of the duration of prophylaxis in the presence of a wound drain. There is insufficient evidence to make a recommendation for or against the early discontinuation of antibiotic prophylaxis in patients with wound drains. (Insufficient)
317978
The use of drains is not recommended as a means to reduce infection rates after single-level surgical procedures. (Insufficient)
317978

Body habitus

Obese patients are at higher risk for postoperative infection, when given a standardized dose of antibiotic prophylaxis. In spite of this conclusion, there is insufficient evidence to make a recommendation for or against recommending a different protocol for patients based on body habitus. (Insufficient)
317978

Comorbidities

In patients with comorbidities or for those undergoing complicated spine surgery, alternative prophylactic regimens are suggested to decrease the incidence of surgical site infections compared with standard prophylaxis regimens. (, )
(Work Group Consensus Statement)
317978
There is insufficient evidence to make a recommendation for or against the specific alternative regimens that are efficacious. However, promising alternative regimens that have been studied include redosing, gram-negative coverage, and the addition of intrawound application of vancomycin or gentamicin. (Insufficient)
317978
Although no literature was available to address this specific question about patients with a history of Methicillinresistant Staphylococcus aureus (MRSA), the search did identify studies that addressed prophylaxis to reduce infections with MRSA. There is insufficient evidence to make a recommendation for or against the prophylactic use of vancomycin compared with other antimicrobial agents to reduce infections with MRSA. (Insufficient)
317978

Complications

Reported isolated complications related to prophylactic antibiotics include flushing, hypotension, rashes, intramembranous colitis and, most seriously, Stevens-Johnson Syndrome. (, )
(Work Group Consensus Statement)
317978
In typical uncomplicated spinal procedures, a single dose of preoperative prophylactic antibiotics with intraoperative redosing as needed is suggested to reduce the risk of complications/adverse events. Reported isolated complications/adverse events related to prophylactic antibiotics are discussed in the previous section and include flushing, hypotension, rashes, intramembranous colitis and, most seriously, Stevens-Johnson Syndrome. (, )
(Work Group Consensus Statement)
317978

Recommendation Grading

Overview

Title

Antibiotic Prophylaxis In Spine Surgery

Authoring Organization

Publication Month/Year

June 20, 2016

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Male, Adult, Older adult

Health Care Settings

Ambulatory, Hospital, Operating and recovery room

Intended Users

Chiropractor

Scope

Assessment and screening, Management, Treatment

Diseases/Conditions (MeSH)

D019072 - Antibiotic Prophylaxis

Keywords

Antibiotic prophylaxis, spine surgery, surgical site infection