Abstract
Background:The rate of postoperative spinal infections varies from 0.4% to 3.5%. Although the introduction of additional preoperative, intraoperative, and postoperative methods of prophylaxis should further reduce spinal infection rates, these measures will not succeed unless surgeons are well informed of their availability, utility, and efficacy. This study provides a review of several preoperative, intraoperative, and postoperative methods of prophylaxis that could minimize the risk of postoperative spinal infections. Various preoperative, intraoperative, and postoperative measures could further reduce the risk of spinal infections. Preoperative prophylaxis against methicillin-resistant Staphylococcus aureus could utilize (1) nasal cultures and Bactroban ointment (mupirocin), and (2) multiple prophylactic preoperative applications of chlorhexidine gluconate (CHG) 4% to the skin. Intraoperative prophylactic measures should not only include the routine use of an antibiotic administered within 60 min of the incision, but should also include copious intraoperative irrigation [normal saline (NS) and/or NS with an antibiotic]. Intraoperatively, instrumentation coated with antibiotics, and/or the topical application of antibiotics may further reduce the infection risk. Whether postoperative infections are reduced with the continued use of antibiotic prophylaxis remains controversial. Other postoperative measures may include utilization of a silver (AgNO3)-impregnated dressing (Silverlon dressing) and the continued use of bed baths with CHG 4%. The introduction of multiple preoperative, intraoperative, and postoperative modalities in addition to standardized prophylaxis may further contribute to reducing postoperative spinal infections.
Highlights
The rate of postoperative spinal infections varies from 0.4% to 3.5%
Even with the availability of antibiotics for prophylaxis and for treating spinal infections, greater attention should once again be paid to the “basics”: the preparation and draping of the patient, avoiding talking at the operating room table, limit the operative time, carefully handling tissue with instruments and not gloved hands, changing gloves frequently, keeping operating room doors closed, limiting traffic, stringently observing new personnel for sterile technique, and minimizing the number of breaks/ change in personnel for scrub technicians, and other personnel are just some of the factors involved in limiting the risks of infection
In cases where the C-reactive protein (CRP) continued to rise after postoperative days 5–7, a new antibiotic was used for the presumptive infection
Summary
Preoperative, intraoperative, and postoperative measures to further reduce spinal infections. Clinical Professor of Neurological Surgery,The Albert Einstein College of Medicine, Bronx, NY 10467, and Chief of Neurosurgical Spine and Education,Winthrop University Hospital, Mineola, NY 11501, USA. This article may be cited as: Epstein NE. Available FREE in open access from: http://www.surgicalneurologyint.com/text.asp? Available FREE in open access from: http://www.surgicalneurologyint.com/text.asp? 2011/1/2/76938
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