The following is a summary of “MRSA Prophylaxis in Spine Surgery Decreases Postoperative Infections,” published in the May 2023 issue of Spinal Disorders and Techniques by Conaway et al.
The design of the study was a retrospective cohort study. The objective is to compare infection rates in patients undergoing lumbar fusion and decompression before and after implementing a quality improvement protocol focusing on methicillin-resistant Staphylococcus aureus (MRSA) screening and decolonization. Prior research has demonstrated that MRSA infections account for many SSIs. Additional research is required to better comprehend the risks and benefits of MRSA decolonization with vancomycin prophylaxis. A retrospective cohort analysis was performed on patients who underwent spinal fusion or laminectomy before (2008–2011) and after (2013–2016) the implementation of an MRSA screening and treatment protocol.
Before and after screening, the odds ratios for MRSA, methicillin-sensitive Staphylococcus aureus (MSSA), and Vancomycin-resistant Enterococcus (VRE) infection were calculated. A multivariate analysis evaluated demographic factors as potential independent infection predictors. They met the inclusion criteria in a cohort of 10,983 patients, 8,425 lumbar fusion, and 2,558 lumbar decompression cases. After protocol implementation, there was a significant decrease in the overall infection rate (P< 0.001), the MRSA infection rate (P<0.001), and the MSSA infection rate (P<0.001). Although the incidence of VRE infections after protocol implementation was not significantly different (P=0.066), the incidence of VRE infections as a proportion of all postoperative infections increased significantly (P=0.007).
On multivariate analysis, significant predictors of disease included younger age (OR=0.94[0.92–0.95]), shorter duration of procedure (OR=1.00[0.99–1.00]), spinal fusion (OR=18.56[8.22–53.28]), higher ASA class (OR=5.49[4.08–7.44]), male sex (OR=1.61[1.18–2.20]), and history of diabetes (OR=1.58[1.08–2.29]). The protocol for quality improvement demonstrated that preoperative prophylactic treatment of MRSA-colonized patients reduced the incidence of overall infections, MSSA infections, and MRSA infections. Additionally, postoperative infection risk factors included younger age, masculine gender, diabetes, higher ASA scores, and spinal fusions.
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