2014, Number 6
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Rev Invest Clin 2014; 66 (6)
Compliance with antibiotic prophylaxis in spinal fusion surgery and surgical wound infection
Rodríguez-Caravaca G, Villar CMC, González-Díaz R, Martínez-Martín J, Toledano-Muñoz A, Durán-Poveda M
Language: English
References: 28
Page: 484-489
PDF size: 155.32 Kb.
ABSTRACT
Background. Surgical wound infection is an important complication
of spinal surgery. Antibiotic prophylaxis has served
to decrease its rates significantly, with the ensuing reduction
in hospital stay, costs, and morbidity and mortality. To date, a
large assessment of the degree of compliance with antibiotic
prophylaxis in spinal fusion surgery has not been undertaken
in Spain with large prospective studies. We sought to assess
the degree of compliance with our antibiotic prophylaxis protocol
among patients who underwent spinal fusion surgery
and its effect on surgical wound infection.
Material and
methods. A prospective cohort study was carried out. Six
hundred and forty patients with at least 1-year clinical followup
who underwent spinal fusion surgery were included. Percentage
of administration and degree of compliance with
protocol was studied. Both overall and the different aspects of
prophylaxis received by patients to those stipulated in the protocol
in force at our hospital were compared. Percentages of
compliance were assessed and the effect of prophylaxis compliance
on the incidence of infection was estimated using the
Relative Risk.
Results. The study covered 640 patients. Overall
compliance with the protocol was 71.5% (95% CI = 67.9-
75.1). The most frequent cause of non-compliance with the
protocol was the duration of recommended antibiotic prophylaxis
(77.8%). Incidence of surgical wound infection was 4.1%
(95% CI: 2.5-5.5). No relationship was found between surgical
wound infection and antibiotic prophylaxis non-compliance
(RR 0.92, 95% CI = 0.38-2.22).
Conclusions. Compliance
and administration of antibiotic prophylaxis were high. Surgical
wound infection rate was similar to those found in the
literature although there is always room for improvement.
REFERENCES
Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008; 36: 309-32.
Rosenberger LH, Politano AD, Sawyer RG. The surgical care improvement project and prevention of post-operative infection, including surgical site infection. Surg Infect (Larchmt) 2011; 12: 163-8.
Owens CD, Stoessel K. Surgical site infections: epidemiology, microbiology and prevention. J Hosp Infect 2008; 70(S2): 3- 10.
Pull ter Gunne AF, van Laarhoven CJ, Cohen DB. Incidence of surgical site infection following adult spinal deformity surgery: an analysis of patient risk. Eur Spine J 2010; 19: 982-8.
Whitehouse JD, Friedman ND, Kirkland KB, Richardson WJ, Sexton DJ. The impact of surgical-site infections following orthopaedic surgery at a community hospital and a university hospital: adverse quality of life, excess length of stay an extra cost. Infect Control Hosp Epidemiol 2002; 23: 183-9.
Meyer D, Klarenbeek R, Meyer F. Current concepts in perioperative care for the prevention of deep surgical site infections in elective spinal surgery. Cent Eur Neurosurg 2010; 71: 117- 20.
Bratzler DW, Houck PM. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Am J Surg 2005; 189: 395-404.
Cháfer M, Domínguez JP, Reyes A, Gorchs M, Ocaña MA, Martín JA, et al. Recomendaciones sobre el tratamiento farmacológico perioperatorio. Cir Esp 2009; 86: 130-8.
Martin C and the French Study Group on Antimicrobial Prophylaxis in Surgery. Antimicrobial prophylaxis in surgery: General concepts and clinical guidelines. Infect Control Hosp Epidemiol 1994; 15: 463-71.
Takahashi H, Wada A, Lida Y, Yokoyama Y, Katori S, Hasegawa K, et al. Antimicrobial prophylaxis for spinal surgery. J Orthop Sci 2009; 14: 40-4.
Barker FG. Efficacy of prophylactic antibiotic therapy in spinal surgery: a meta-analysis. Neurosurgery 2002; 51: 391-401.
Bowater RJ, Stirling SA, Lilford RJ. Is Antibiotic Prophylaxis in Surgery a Generally Effective Intervention? Testing a Generic Hypothesis Over a Set of Meta-Analyses. Ann Surg 2009; 249: 551-6.
Willems L, Simoens S, Laekeman G. Follow-up of antibiotic prophylaxis: impact on compliance with guidelines and financial outcomes. J Hosp Infect 2005; 60: 333-9.
Rodríguez-Caravaca G, Santana-Ramírez S, Villar-del-Campo MC, Martín-López R, Martínez-Martín J, Gil-de-Miguel A. Evaluación de la adecuación de la profilaxis antibiótica en cirugía ortopédica y traumatológica. Enferm Infecc Microbiol Clin 2010; 28: 17-20.
Pons-Busom M, Aguas-Compaired M, Delás J, Eguileor-Partearroyo B. Compliance with local guidelines for antibiotic prophylaxis in surgery. Infect Control Hosp Epidemiol 2004; 25: 308-12.
Miliani K, L’Hériteau F, Astagneau P, and INCISO Network Study Group. Non-compliance with recommendations for the practice of antibiotic prophylaxis and risk of surgical site infection: results of a multilevel analysis from the INCISO Surveillance Network. J Antimicrob Chemother 2009; 64: 1307-15.
Watters WC 3rd, Baisden J, Bono CM, Heggeness MH, Resnick DK, Shaffer WO, et al. Antibiotic prophylaxis in spine surgery: an evidence-based clinical guideline for the use of prophylactic antibiotics in spine surgery. Spine J 2009; 9: 142-6.
Lissovoy G, Fraeman K, Hutchins V, Murphy D, Song D, Vaughn BB. Surgical site infection: Incidence and impact on hospital utilization and treatment costs. Am J Infect Control 2009; 37: 387-97.
Classen DC, Evans RS, Pestotnik SL, Horn SD, Menlove RL, Burke JP. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med 1992; 326: 281-6.
Pull ter Gunne AF, van Laarhoven CJ, Cohen DB. Incidence of surgical site infection following adult spinal deformity surgery: an analysis of patient risk. Eur Spine J 2010; 19: 982-8.
Núñez-Pereira S, Pellisé F, Rodríguez-Pardo D, Pigrau C, Sánchez JM, Bagó J, et al. Individualized antibiotic prophylaxis reduces surgical site infections by gram-negative bacteria in instrumented spinal surgery. Eur Spine J 2011; 20(S3): 397- 04.
Simchen E, Stein H, Sacks TG, Shapiro M, Michel J. Multivariate analysis of determinants of postoperative wound infection in orthopaedic patients. J Hosp Infect 1984; 5: 137-46.
Vilar-Compte D, García-Pasquel MJ. Perioperative antibiotic prophylaxis in cancer surgery. Rev Invest Clin 2011; 63: 630- 40.
Quintas Viqueira A, Rodríguez Caravaca G. Quesada Rubio JA, Soler Francés V. Surgical Site Infection Rates and Risk Factors in Orthopedic Pediatric Patients in Madrid, Spain. Pediatr Infect Dis J 2014; 33: 693-6.
Acín-Gándara D, Rodríguez-Caravaca G, Durán-Poveda M, Pereira-Pérez F, Fernández-Cebrián JM, Quintans-Rodríguez A. Incidence of Surgical Site Infection in Colon Surgery. Comparison with a regional (Madrid), national (Spain) an US standard. Surg Infect (Larchmt) 2013; 14: 339-44.
Buffet-Bataillon S, Haegelen C, Riffaud L, Bonnaure-Mallet M, Brassier G, Cormier M. Impact of surgical site infection surveillance in a neurosurgical unit. J Hosp Infect 2011; 77: 352-5.
Díaz-Agero-Pérez C, Pita-López MJ, Robustillo-Rodela A, Figuerola-Tejerina A, Monge-Jodrá V. Evaluación de la infección de herida quirúrgica en 14 hospitales de la Comunidad de Madrid: estudio de incidencia. Enferm Infecc Microbiol Clin 2011; 29: 257-62.
van Middendorp JJ, Pull Ter Gunne DA, Schuetz M, Habil D, Cohen DB, Hosman AJ, et al. A Methodological Systematic Review on Surgical Site Infections Following Spinal Surgery. Part 2: Prophylactic Treatments. Spine (Phila Pa 1976) 2012; 37: 2034-45.