Resident Physician MedStar Georgetown University Hospital Washington, District of Columbia, United States
Introduction: Closed suction drains used in posterior spinal surgery pose a significant risk of surgical site infection (SSI). To combat this risk, many surgeons opt for prolonged prophylactic systemic antibiotic (PPSA) regimen. The objective of this systematic review was to investigate whether a regimen of PPSA reduces the incidence of deep SSIs in adult patients with closed suction drains following posterior spinal surgeries.
Methods: A systematic review of the literature in Pubmed (Medline), Europe PMC, Embase, and Cochrane Review databases was conducted using such keywords as “spine,” “antibiotics,” “surgical site infection,” “prophylaxis,” “drain”. Retrospective and prospective studies investigating the effectiveness of PPSA in patients 18 years or older who underwent posterior cervical or thoracolumbar surgery and had postoperative wound drains were included. The primary outcome was the odds ratio of deep SSI based on the intervention (PPSA vs non-PPSA). The secondary outcomes were the rates of superficial and overall SSIs.
Results: From a total of 2,558 titles identified from the search, 7 studies were chosen for final analysis. Three were randomized clinical trials (RCTs), while four were retrospective reviews. A total of 2446 patients were analyzed - 1149 received a PPSA regimen and 1297 received a non-PPSA regimen. Deep SSIs occurred in 45 patients (3.9%) and 46 patients (3.5%) in PPSA and non-PPSA groups, respectively, which was not significantly different. Additionally, there were no differences in rates of superficial and overall SSIs. There was a trend towards increased number of infections with multidrug resistant bacteria (Pseudomonas and Methicillin Resistant Staphylococcus aureus [MRSA]) in the PPSA group, however it was not possible to perform a durable statistical analysis due to low number of reported organisms in the selected publications.
Conclusion : This meta-analysis demonstrates that there is no reduction in rates of deep, superficial, and overall SSIs with prolonged prophylactic antibiotics after posterior spinal surgery involving the use of closed suction drains.
How to Improve Patient Care: The findings of this investigation can encourage limiting the use of prophylactic antibiotics for spinal drains after posterior spinal surgery
