Effectiveness of Oral Antibiotic Therapy in Prevention of Postoperative Wound Infection Requiring Surgical Washout In Spine Surgery

Prediction models for risk assessment of surgical site infection after spinal surgery: A systematic review

Background

Spinal surgeries are a common procedure, but there is significant risk of adverse events following these operations. While the rate of adverse events ranges from 8% to 18%, surgical site infections (SSIs) alone occur in between 1% and 4% of spinal surgeries.

Methods

We completed a systematic review addressing factors that contribute to surgical site infection after spinal surgery. From the included studies, we separated the articles into groups based on whether they propose a clinical predictive tool or model. We then compared the prediction variables, model development, model validation, and model performance.

Results

About 47 articles were included in this study: 10 proposed a model and 5 validated a model. The models were developed from 7,720 participants in total and 210 participants with SSI. Only one of the proposed models was externally validated by an independent group. The other 4 validation papers examined the performance of the ACS NSQIP surgical risk calculator.

Conclusions

While some preoperative risk models have been validated, and even successfully implemented clinically, the significance of postoperative SSIs and the unique susceptibility of spine surgery patients merits the development of a spine-specific preoperative risk model. Additionally, comprehensive and stratified risk modeling for SSI would be of invaluable clinical utility and greatly improve the field of spine surgery.

Management of nonpurulent wound drainage following spinal surgery: is empiric oral antibiotic treatment appropriate?

BACKGROUND CONTEXT

Postoperative incisional concerns including nonpurulent drainage are relatively common following spine surgery. Evidence-based management protocols are lacking.

PURPOSE

The purpose of this study is to determine if prescribing empiric oral antibiotics for nonpurulent wound drainage is beneficial for the prevention of chronic infection or reoperation.

STUDY DESIGN

Retrospective chart review.

PATIENT SAMPLE

Patients calling the office with postsurgical wound concerns.

OUTCOME MEASURES

Not applicable.

METHODS

In a large, multisurgeon, spine surgery practice, a review of the communications log showed that 298 patients called or messaged the office with a concern regarding postoperative nonpurulent wound drainage. Patients were prescribed empiric oral antibiotics based on surgeon preference. Patients who received empiric oral antibiotic treatment (AbxTx) were propensity matched to patients who did not (No AbxTx) based on sex, age, BMI, ASA grade, smoking status, prior spine surgery, anatomic location, and number of surgical levels. The number of patients requiring surgical intervention (debridement) and/or developing a chronic infection was determined.

RESULTS

Oral antibiotics were prescribed for 112 of the 298 (38%) patients with reports of nonpurulent drainage. Demographic and surgical characteristics of the two matched cohorts were similar. Although there were more patients in the AbxTx group who required surgical intervention (n=17, 17%) compared to the No AbxTx group (n=9, 9%), this difference was not statistically significant (p=.139). The intra-operative culture results showed no growth in 94% (16/17) of the AbxTx group vs 67% (6/9) of the No AbxTx group (p=.103). One patient in each group required a return to the operating room within the year after the initial surgical debridement for management of chronic infection.

CONCLUSION

In this large series (n=298) of patients with nonpurulent wound drainage following spine surgery, 87% resolved without the need for surgical intervention. Empiric oral antibiotics did not reduce the need for surgical intervention or the development of a chronic infection. In addition to the added cost, potential adverse reactions, development of resistant organisms, and inaccurate labeling of surgical site infection; empiric oral antibiotics may lead to a negative intraoperative culture for those requiring surgical intervention impacting the ability to prescribe a specific antibiotic regimen.

Application of Graphene Oxide in Oral Surgery: A Systematic Review

The current review aims to provide an overview of the most recent research in the last 10 years on the potentials of graphene in the dental surgery field, focusing on the potential of graphene oxide (GO) applied to implant surfaces and prosthetic abutment surfaces, as well as to the membranes and scaffolds used in Guided Bone Regeneration (GBR) procedures. "Graphene oxide" and "dental surgery" and "dentistry" were the search terms utilized on the databases Scopus, Web of Science, and Pubmed, with the Boolean operator "AND" and "OR". Reviewers worked in pairs to select studies based on specific inclusion and exclusion criteria. They included animal studies, clinical studies, or case reports, and in vitro and in vivo studies. However, they excluded systematic reviews, narrative reviews, and meta-analyses. Results: Of these 293 studies, 19 publications were included in this review. The field of graphene-based engineered nanomaterials in dentistry is expanding. Aside from its superior mechanical properties, electrical conductivity, and thermal stability, graphene and its derivatives may be functionalized with a variety of bioactive compounds, allowing them to be introduced into and improved upon various scaffolds used in regenerative dentistry. This review presents state-of-the-art graphene-based dental surgery applications. Even if further studies and investigations are still needed, the GO coating could improve clinical results in the examined dental surgery fields. Better osseointegration, as well as increased antibacterial and cytocompatible qualities, can benefit GO-coated implant surgery. On bacterially contaminated implant abutment surfaces, the CO coating may provide the optimum prospects for soft tissue sealing to occur. GBR proves to be a safe and stable material, improving both bone regeneration when using GO-enhanced graft materials as well as biocompatibility and mechanical properties of GO-incorporated membranes.

CHARACTERISTICS OF WOUND INFECTIONS AND METHODS OF THEIR TREATMENT USING PREPARATIONS OF BIOLOGICAL ORIGIN

Surgical wound infections are the most common patients’ complications in the postoperative period. In the modern clinic, they worsen the disease prognosis and remain the most important and acute health problem in all countries of the world. The aim of the work was to analyze current scientific data on the peculiarities of the pathogenesis of wound infections and types of their pathogens, as well as drugs of biological origin in the treatment of wound infections. The paper discusses in detail the problem of infection of wound injuries during surgery and domestic injuries of various kinds. The main pathogens of wound infections are considered. Specific pathogenicity factors for bacteria of the genera Staphylococcus, Pseudomonas, Enterobacteriaceae were analyzed. Based on the analysis of literature sources, a list of drugs of biotechnological origin that can be effectively used in combination therapy for the treatment and prevention of wound infections was determined. Conclusions. The result is the identification of those mechanisms of pathogenesis of wound infections that determine the effectiveness of the use of drugs of biological origin in this pathology treatment.