Six-week antibiotic treatment is sufficient for early spinal surgery site infections, according to data published in Clinical Infectious Diseases.
The current treatment duration recommendation for spinal surgery site infections is 12 weeks. To investigate the efficacy of a shorter 6-week antibiotic treatment, investigators conducted a prospective study of 85 patients from a single teaching hospital between November 2014 and July 2017. After surgical management of a spinal surgery site infection, patients received broad-spectrum antibiotics intravenously for 10 days, and orally for the remainder of the total 6 weeks. Success was defined as the absence of relapse, superinfection, or surgical failure at the end of treatment and at 1-year follow-up.
Investigators noted that the overall success rate for 6-week antibiotic treatment of spinal surgery site infection was 91.8%, and that treatment failure after termination of treatment occurred in 1.2% of patients. The median delay between the initial surgical procedure and diagnosis with a spinal surgery site infection was 16 days. Spinal surgery site infections were monomicrobial in 76.4% of cases, with Staphylococcus aureus being found in 46% of these. In 8.2% of all cases, failure was observed, with approximately half being caused by anaerobic bacteria. Risk for treatment failure was found to be associated with infection with Enterobacteriaceae and the extent of anatomical surgical intervention.
The study benefited from a prospective nature of design, which allowed comprehensive data collection and from being conducted at a single center. This guaranteed the consistency of surgical and medical practices conducted by staff members. However, the single-center aspect of design also presented a limitation, as there was no control group for comparison.
When considering treatment for spinal surgery site infection, antibiotic resistance is a concern, and this study demonstrated the efficacy of shortening treatment to 6 weeks. Investigators concluded that “the shortening of treatment would alleviate possible undesired effects and reduce cost and average hospital stay.”
Fernandez-Gerlinger MP, Arvieu R, Lebeaux D, et al. Successful six-week antibiotic treatment for early surgical-site infections in spinal surgery [published online September 20, 2018]. Clin Infect Dis. doi: 10.1093/cid/ciy805