Original ArticlesTopical irrigation with polymyxin and bacitracin for spinal surgery
Section snippets
Clinical materials and methods
Nyack Hospital and Community Hospital at Dobbs Ferry are located in suburban counties approximately 20 miles from New York City. Our series included 50 consecutive spinal operations from June 1995 through September 1996. There were 27 men and 23 women with ages ranging from 16 to 65. The cases included 22 arthroscopic microdiscectomies, 18 lumbar laminotomies for excision of a herniated nucleus pulposus, and 10 anterior cervical discectomies. None of the patients had any known infection before
Results
No wound infections were documented in the 50 consecutive patients who underwent spinal surgery during the 16 months of our study. Table 1 summarizes the isolates and sources of the various potential pathogens identified. Staphylococci were cultured from 48 out of 50 patients’ skin cultures and from 40 out of 50 cultures of the operating room environment. Coagulase-negative Staphylococcus species was the most common bacterial isolate, and 21% were resistant to cefazolin at both hospitals. Of
Discussion
Because of the limitation of longitudinal clinical studies, which cannot follow the parameters of animal laboratory research, the authors have tried to assess systemic and topical prophylactic antibiotics by focusing on sources of contamination, the antibiotic sensitivity of organisms cultured during neurosurgical procedures, and the occurrence of intraoperative growth of potential pathogens. Given the methodology and the unwillingness to consider placebos which would place patients at
Conclusions
Five separate studies of the bacteriologic factors in neurosurgical operations have now been completed at one university medical center and three community hospitals where the rate of wound infection in clean neurosurgical cases has remained close to zero. The methodology has been carefully planned and consistently applied. Sampling techniques were established in the first study at Nyack Hospital [17], and bacteriologic testing for all of the projects was conducted at the same microbiology
Acknowledgements
The authors wish to thank the other members of the Microbiology Laboratory of Nyack Hospital for their excellent technical assistance.
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Cited by (27)
History and Use of Antibiotic Irrigation for Preventing Surgical Site Infection in Neurosurgery: A Scoping Review
2022, World NeurosurgeryCitation Excerpt :It should be noted that some of these variables are hard to compare directly to the original Malis study as it did not include a demographic or case breakdown.9 Three more recent studies identified branched off from direct SSI evaluation to include surgical site microorganism investigations in comparison with SSI development and the analysis of factors that influence the risk of SSI development.3,17,18 These branching studies allow for a broader understanding of the extent to which contributory factors influence the efficacy of antibiotic irrigation in preventing SSI development.
Operative Environment
2014, Journal of ArthroplastyCitation Excerpt :In vitro and animal studies using bone or metal surfaces failed to show better performance for neomycin and bacitracin solutions in comparison with normal saline for removing bacteria from bone, titanium, and stainless steel [190–192]. Despite evidence that topical antibiotics decrease bacterial inoculum in clean surgical wounds [210], it has not been shown that they offer any advantage over intravenous antibiotic prophylaxis, nor that they have been proven to decrease the incidence of SSI [184,186]. A study of a canine model for TJA reported a reduction in the SSI rate with neomycin containing irrigation solution [211].
Metal binding and structure-activity relationship of the metalloantibiotic peptide bacitracin
2002, Journal of Inorganic Biochemistry