2128. Predictors of Post-Discharge Prophylactic Antibiotics Following Spinal Fusion
Session: Poster Abstract Session: Healthcare Epidemiology: Surgical Site Infections
Saturday, October 6, 2018
Room: S Poster Hall
Posters
  • Predictors of Post-Discharge Prophylactic Antibiotics Following Spinal Fusion.pdf (475.7 kB)
  • Background: Discontinuation of prophylactic antibiotics < 24 hours after surgery is recommended in multiple guidelines, but prophylactic antibiotics are still prescribed at discharge for some procedures. The objective of this study was to determine the prevalence and predictors of post-discharge prophylactic antibiotic use after spinal fusion.
    Methods: We established a retrospective cohort of patients (pts) aged ≥18 years undergoing spinal fusion between 7/2010 and 6/2015 at 3 teaching hospitals. We excluded pts with infections during the spinal fusion admission. Prophylactic antibiotics were identified at discharge.
    Results: 9690 spinal fusion admissions were identified. The median age of pts was 57 years; 4425 (45.7%) were male; 1070 (11.0%) were trauma pts; and 352 (3.6%) had underlying malignancy. Antibiotic(s) were prescribed at discharge in 381 (3.9%) admissions. The most commonly prescribed antibiotics were trimethoprim/sulfamethoxazole (23.4%), ciprofloxacin (16.4%) and cephalexin (16.1%). Independent predictors of prophylactic discharge antibiotics are shown in the Table.
    Conclusion: Post-discharge prophylactic antibiotics were uncommon after spinal fusion. Factors associated with use included hospital, trauma, prolonged surgery time, intra-operative antibiotics, plus patient factors, including obesity, malignancy, fluid and electrolyte disorders, valvular heart disease and high American Society of Anesthesiologists (ASA) score.

     

    Risk Factor

    Odds Ratio (95% Confidence Interval)

    Hospital

     

      1

    Referent

      2

    2.49 (1.83, 3.41)

      3

    1.79 (1.36, 2.35)

    Morbid obesity

    1.64 (1.15, 2.36)

    Hypothyroidism

    1.34 (0.96, 1.87)

    Fluid and electrolyte disorders

    1.53 (1.13, 2.07)

    Paralysis

    1.71 (0.97, 2.98)

    Valvular heart disease

    1.83 (1.14, 2.95)

    Malignancy

    2.03 (1.37, 3.01)

    ASA score ≥ 3

    1.42 (1.13, 1.78)

    Hematoma/seroma

    2.40 (0.99, 5.83)

    Trauma patient

    1.76 (1.33, 2.33)

    Cervical spinal fusion

    0.78 (0.62, 1.00)

    Thoracic spinal fusion

    1.29 (0.97, 1.70)

    Intraoperative IV antibiotics

     

      Cefazolin or clindamycin

    Referent

      Vancomycin

    1.52 (1.02, 2.28)

      Other IV antibiotic or >1 IV antibiotic

    1.55 (1.18, 2.02)

      None

    3.11 (1.85, 5.25)

    Surgery time ≥90 minutes

    1.81 (1.10, 2.97)

     

    David K. Warren, MD, MPH, FIDSA, FSHEA1, Katelin B. Nickel, MPH1, Ian Banks, pre-BA1, Jennifer H. Han, MD, MSCE2,3, Pam Tolomeo, MPH3, Christopher Hostler, MD, MPH4, Katherine Foy, RN4, Victoria Fraser, MD, FIDSA, FSHEA5, Margaret A. Olsen, PhD, MPH1,6 and for the CDC Prevention Epicenter Program, (1)Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, (2)Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, (3)Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, (4)Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC, (5)Department of Medicine, Washington University School of Medicine, Saint Louis, MO, (6)Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO

    Disclosures:

    D. K. Warren, None

    K. B. Nickel, None

    I. Banks, None

    J. H. Han, None

    P. Tolomeo, None

    C. Hostler, None

    K. Foy, None

    V. Fraser, None

    M. A. Olsen, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.