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Post-Discharge Antibiotic Use for Prophylaxis Following Spinal Fusion
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7 2020
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Source: Infect Control Hosp Epidemiol. 41(7):789-798
Details:
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Alternative Title:Infect Control Hosp Epidemiol
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Personal Author:
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Description: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 post-discharge prophylactic antibiotic use after spinal fusion.
Design:
Multicenter retrospective cohort.
Patients:
Patients aged ≥ 18 years undergoing spinal fusion or refusion from 7/2011–6/2015 at three sites. Patients with infection during the surgical admission were excluded.
Methods:
Prophylactic antibiotics were identified at discharge. Factors associated with post-discharge prophylactic antibiotic use were identified using hierarchical generalized linear models.
Results:
8,652 spinal fusion admissions were included. Antibiotics were prescribed at discharge in 289 (3.3%) admissions. 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 intra-operative antibiotics.
Conclusions:
Post-discharge prophylactic antibiotics were uncommon after spinal fusion. Patient and perioperative factors were associated with continuation of prophylactic antibiotics after hospital discharge.
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Source:
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Pubmed ID:32366333
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Pubmed Central ID:PMC7641990
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