Assessing Risk of Spinal Surgical Site Infection in a Mrsa-precolonized Minority Patient Population

Introduction: Surgical site infections (SSIs) represent the third most common complication following spinal procedures ranging in prevalence from 0.2-16.1%. Methicillin-resistant Staphylococcus aureus (MRSA) infections that accounts for 23.1-34.3% of SSIs. Current perioperative practice for the prevention of SSIs entails intravenous administration of cefazolin 30 minutes before incision. Patients with known MRSA risk assessed through nasal colonization or surgical history may receive other prophylaxis.

Methods: Patients undergoing spinal surgery will be enrolled in a prospective study beginning September 2024 with an anticipated conclusion by March 2025. Surgeries will be performed by a single surgeon operating at an urban level-1 trauma center; the respective population consisting mostly of minority patients. Patient eligibility to be determined by chart review and a questionnaire including a thorough history of previous surgery, hospitalization, infection, injury, use of antibiotics. MRSA nasal swab culture will be used to determine if patients are MRSA-colonized preoperatively. Cultures of SSIs, will be used to identify if a patient is infected with MRSA or another causative agent. Retrospective analysis of data from July 2010 through September 2024 will be conducted on patients eighteen and older who were found to be MRSA positive within 3 months of spine surgery.

Results: Given that methicillin-resistant Staphylococcus aureus (MRSA) infections account for 23.1-34.3% of SSIs, it stands to reason that prophylactic treatment with antibiotics effective in MRSA eradication, when indicated by preoperative MRSA colonization, may lessen the likelihood of SSIs. Assessing the results of nasal swabs, demographic information, and patient history collected by survey may reveal patients who are at increased risk for infections including MRSA following spinal procedures. We hope this information may provide insight into changes possible for SSI prevention through patient specific antibiotic prophylaxis.

Conclusion : Usage of vancomycin in the absence of MRSA can increase risk of SSIs, potentiate systemic inflammatory responses, and encourage multidrug resistance among surgical populations underscoring the necessity of employing it only if strictly necessary. As such, further studies need to be conducted in assessing MRSA risk and optimizing antibiotic prophylaxis.