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Postdischarge antibiotic use for prophylaxis following spinal fusion

Published online by Cambridge University Press:  05 May 2020

David K. Warren Open the ORCID record for David K. Warren [Opens in a new window] ,
Katelin B. Nickel Open the ORCID record for Katelin B. Nickel [Opens in a new window] ,
Jennifer H. Han ,
Pam Tolomeo Open the ORCID record for Pam Tolomeo [Opens in a new window] ,
Christopher J. Hostler Open the ORCID record for Christopher J. Hostler [Opens in a new window] ,
Katherine Foy ,
Ian R. Banks ,
Victoria J. Fraser Open the ORCID record for Victoria J. Fraser [Opens in a new window] ,
Margaret A. Olsen Open the ORCID record for Margaret A. Olsen [Opens in a new window]  and
for the CDC Prevention Epicenter Program
David K. Warren*
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
Katelin B. Nickel
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
Jennifer H. Han
Affiliation:
Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Pam Tolomeo
Affiliation:
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Christopher J. Hostler
Affiliation:
Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, North Carolina Infectious Diseases Section, Durham VA Health Care System, Durham, North Carolina
Katherine Foy
Affiliation:
Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, North Carolina
Ian R. Banks
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
Victoria J. Fraser
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
Margaret A. Olsen
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri Division of Public Health Sciences, Washington University School of Medicine, St Louis, Missouri (Present affiliation: GlaxoSmithKline, Rockville, MD [J.H.H.].)
*
Author for correspondence: David K. Warren, E-mail: dwarren@wustl.edu
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Abstract

Objective:

Despite recommendations to discontinue prophylactic antibiotics after incision closure or <24 hours after surgery, prophylactic antibiotics are continued after discharge by some clinicians. The objective of this study was to determine the prevalence and factors associated with postdischarge prophylactic antibiotic use after spinal fusion.

Design:

Multicenter retrospective cohort study.

Patients:

This study included patients aged ≥18 years undergoing spinal fusion or refusion between July 2011 and June 2015 at 3 sites. Patients with an infection during the surgical admission were excluded.

Methods:

Prophylactic antibiotics were identified at discharge. Factors associated with postdischarge prophylactic antibiotic use were identified using hierarchical generalized linear models.

Results:

In total, 8,652 spinal fusion admissions were included. Antibiotics were prescribed at discharge in 289 admissions (3.3%). The most commonly prescribed antibiotics were trimethoprim/sulfamethoxazole (22.1%), cephalexin (18.8%), and ciprofloxacin (17.1%). Adjusted for study site, significant factors associated with prophylactic discharge antibiotics included American Society of Anesthesiologists (ASA) class ≥3 (odds ratio [OR], 1.31; 95% CI, 1.00–1.70), lymphoma (OR, 2.57; 95% CI, 1.11–5.98), solid tumor (OR, 3.63; 95% CI, 1.62–8.14), morbid obesity (OR, 1.64; 95% CI, 1.09–2.47), paralysis (OR, 2.38; 95% CI, 1.30–4.37), hematoma/seroma (OR, 2.93; 95% CI, 1.17–7.33), thoracic surgery (OR, 1.39; 95% CI, 1.01–1.93), longer length of stay, and intraoperative antibiotics.

Conclusions:

Postdischarge prophylactic antibiotics were uncommon after spinal fusion. Patient and perioperative factors were associated with continuation of prophylactic antibiotics after hospital discharge.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 7 , July 2020 , pp. 789 - 798
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Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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Footnotes

PREVIOUS PRESENTATION: This work was presented at IDWeek 2018 in San Francisco, California, on October 6, 2018.

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