The Journal of surgical research · 2024
Antibiotic Prophylaxis and Spinal Infection After Gunshot Wounds to the Spine: A Retrospective Study.
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Gellings Jaclyn A, Haberman Kathryn, Al Tannir Abdul Hafiz, Carver Thomas, Peschman Jacob
Аннотация
INTRODUCTION: Spinal and paraspinal infections (SPIs) are a potential complication following traumatic spinal column injury, and we sought to determine the association of antibiotic prophylaxis on SPI development following a spinal gunshot wound (GSW).
METHODS: A single-center retrospective cohort study was performed on adults who sustained a GSW to the spinal column over 11 y. Patients were excluded if they died within 24 h or had a mechanism other than GSW. Antibiotic use and injury patterns were analyzed.
RESULTS: A total of 330 patients were included in analysis. Most were male (88%), Black (79%), and averaged 27 y old. Mortality was 4%. Prophylactic antibiotics were administered in 65%; and median duration was 5 d. Nine patients (2.7%) developed SPI. Hollow viscus injury (HVIs) (66.7% versus 23.1%, P < 0.001), primarily colon injuries (55.6% versus 12.5%, P < 0.001), were independently associated with SPI. Antibiotic use was not associated with a decrease in SPI (3% versus 2%; P = 0.41). Of the patients who developed SPI, seven received 3 d of antibiotics or less, and this was not statistically significant (P = 0.49).
CONCLUSIONS: Patients with HVIs have a higher incidence of SPI, following spinal GSW. Although antibiotic use and duration did not have a statistically significant association with SPI, no patient, even with HVIs, who received 4 or more days of antibiotics developed an infection. Due to the low incidence of SPI, a multicenter trial may help determine the optimal duration of prophylactic antibiotics. However, we recommend a maximum of 4 d of antibiotics for SPI prophylaxis following GSW.
METHODS: A single-center retrospective cohort study was performed on adults who sustained a GSW to the spinal column over 11 y. Patients were excluded if they died within 24 h or had a mechanism other than GSW. Antibiotic use and injury patterns were analyzed.
RESULTS: A total of 330 patients were included in analysis. Most were male (88%), Black (79%), and averaged 27 y old. Mortality was 4%. Prophylactic antibiotics were administered in 65%; and median duration was 5 d. Nine patients (2.7%) developed SPI. Hollow viscus injury (HVIs) (66.7% versus 23.1%, P < 0.001), primarily colon injuries (55.6% versus 12.5%, P < 0.001), were independently associated with SPI. Antibiotic use was not associated with a decrease in SPI (3% versus 2%; P = 0.41). Of the patients who developed SPI, seven received 3 d of antibiotics or less, and this was not statistically significant (P = 0.49).
CONCLUSIONS: Patients with HVIs have a higher incidence of SPI, following spinal GSW. Although antibiotic use and duration did not have a statistically significant association with SPI, no patient, even with HVIs, who received 4 or more days of antibiotics developed an infection. Due to the low incidence of SPI, a multicenter trial may help determine the optimal duration of prophylactic antibiotics. However, we recommend a maximum of 4 d of antibiotics for SPI prophylaxis following GSW.