Intra-operative use of antibiotic irrigation does not reduce infection rates in neurosurgical procedures involving device implantation

Jennifer Meyer UC COM MS2 (medical student); Dr. Daryn Cass1; Dr. Rebecca Garner 1; Dr. Juan Torres-Reveron1 (PI)

University of Cincinnati Department of Neurosurgery1

 Surgical site infections are a large source of peri-operative morbidity. In cases where medical devices are implanted, a surgical site infection may require revision surgery for removal of hardware in order to definitively treat the infection. The use of intra-operative antibiotic irrigation to the surgical site has become common place in surgical procedures, including in neurosurgical procedures requiring implantation of devices such as spinal hardware, deep brain stimulation electrodes and generators, and intrathecal pumps. Bacitracin in saline or lactated ringer’s solution is the most commonly used antibiotic for this purpose. Despite its widespread use, this is an off-label use of bacitracin, and in January of 2020, the FDA recommended ceasing the use of intra-operative bacitracin irrigation, as the risks of its use, such as nephrotoxicity and anaphylactic reactions, were deemed to outweigh the potential benefits. Despite this recommendation, bacitracin’s off-label use during device placement remains frequent, in part due to the lack of studies demonstrating a clear benefit or lack thereof. In this study, we retrospectively reviewed a single surgeon’s surgical site infection rates requiring device explantation in patients who underwent implantation of deep brain stimulator electrodes, vagal nerve stimulators, spinal cord stimulators, intrathecal pumps, or replacement of the generators associated with these devices. We compared infection rates from 584 surgeries over a four year time period, during which the use of antibiotic irrigation was discontinued. We found that there was no significant difference in infection rates with antibiotic and saline irrigation use versus use of saline irrigation alone, supporting the FDA’s recommendation against the off-label use of intra-operative antibiotic irrigation. 

Contact: Jennifer Meyer, meyer4jl@mail.uc.edu, (317)628-5321

Key Words: Bacitracin; Surgical site infections; Deep brain stimulators; Spinal electronic devices; Intrathecal pumps