The spine journal : official journal of the North American Spine Society · 2026
Infections in noninstrumented spine surgery: is the discontinuation of antibiotic prophylaxis to blame?
СтатьяНазвание и аннотация: Перевод в очереди
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Planty-Bonjour Alexia, Lacasse Marion, Solera Adrien, Labrousse Rodolphe, Loubeyre Elise, Aggad Mourad, Francois Patrick, Zemmoura Ilyess, Terrier Louis-Marie, Amelot Aymeric
Аннотация
BACKGROUND CONTEXT: Noninstrumented spine surgery (NISS) remains a common procedure. Surgical site infections (SSIs) are common complications. Since 2024, the official French guidelines recommend discontinuing preoperative antibiotic prophylaxis. Prior to 2024, preoperative antibiotics were routinely administered.
PURPOSE: To compare the rate of SSIs after NISS in patients operated with vs without antibiotic prophylaxis.
STUDY DESIGN: Single-center retrospective comparative series.
PATIENT SAMPLE: A total of 651 patients underwent elective NISS between January 2022 and June 2025.
OUTCOME MEASURES: Infection rate, infection risk factors and bacteriology.
METHODS: A total of 2 successive antibiotic prophylaxis protocols were used: from 2022 to 2023 (group A: prophylactic cefazolin antibiotic approximately 30-60 minutes before the incision) and from 2024 to 2025 (group B: no prophylactic antibiotic).
RESULTS: Within our series of 651 patients (401 in group A and 250 in group B), we identified 26 surgical site infections. The infection rates were 0.99% in Group A (4/401) vs 8.8% in Group B (22/250) (p=.002). Infections in group B were more severe, with nearly 50% associated with serious complications (spondylodiscitis, bacteremia and endocarditis). Staphylococci predominated in both groups, but Gram-negative bacilli appeared only in Group B. Multiple logistic regression hazard model identified that ASA score 1 [HR: 0.027, 95% CI) 0.005-0.150; p<.0001], ASA score 2 [HR: 0.038, 95% CI: 0.008 to 0.119; p<.0001] and prophylactic antibiotics [HR: 0.048, 95% CI .011-.202; p<.0001] were independent factors that significantly reduced infections. In contrast, we found diabetes [HR: 3.120, 95% CI 1.091-8.924; p=.0034] was an independent predictive risk factor for SSI. Obesity (193/651 patients, p=.181) or immunosuppressive treatments (43/651 patients, p=.861) did not appear to be risk factors for SSI.
CONCLUSION: The elimination of preoperative/preincision antibiotic prophylaxis led to a significant (8-fold) increase in SSI incidence and severity. These findings confirm prior data. We hope that this publication supports reevaluating current French guidelines.
PURPOSE: To compare the rate of SSIs after NISS in patients operated with vs without antibiotic prophylaxis.
STUDY DESIGN: Single-center retrospective comparative series.
PATIENT SAMPLE: A total of 651 patients underwent elective NISS between January 2022 and June 2025.
OUTCOME MEASURES: Infection rate, infection risk factors and bacteriology.
METHODS: A total of 2 successive antibiotic prophylaxis protocols were used: from 2022 to 2023 (group A: prophylactic cefazolin antibiotic approximately 30-60 minutes before the incision) and from 2024 to 2025 (group B: no prophylactic antibiotic).
RESULTS: Within our series of 651 patients (401 in group A and 250 in group B), we identified 26 surgical site infections. The infection rates were 0.99% in Group A (4/401) vs 8.8% in Group B (22/250) (p=.002). Infections in group B were more severe, with nearly 50% associated with serious complications (spondylodiscitis, bacteremia and endocarditis). Staphylococci predominated in both groups, but Gram-negative bacilli appeared only in Group B. Multiple logistic regression hazard model identified that ASA score 1 [HR: 0.027, 95% CI) 0.005-0.150; p<.0001], ASA score 2 [HR: 0.038, 95% CI: 0.008 to 0.119; p<.0001] and prophylactic antibiotics [HR: 0.048, 95% CI .011-.202; p<.0001] were independent factors that significantly reduced infections. In contrast, we found diabetes [HR: 3.120, 95% CI 1.091-8.924; p=.0034] was an independent predictive risk factor for SSI. Obesity (193/651 patients, p=.181) or immunosuppressive treatments (43/651 patients, p=.861) did not appear to be risk factors for SSI.
CONCLUSION: The elimination of preoperative/preincision antibiotic prophylaxis led to a significant (8-fold) increase in SSI incidence and severity. These findings confirm prior data. We hope that this publication supports reevaluating current French guidelines.