ANTIBIOTIC PROPHYLAXIS IN SPINE SURGERY

  ANTIBIOTIC PROPHYLAXIS IN SPINE SURGERY     TECHNICAL REPORT (2012)    I. Literature Search Parameters………………………………………………………………………...2  II. Evidenti...
Author: Harry Moore
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ANTIBIOTIC PROPHYLAXIS IN SPINE SURGERY     TECHNICAL REPORT (2012)    I. Literature Search Parameters………………………………………………………………………...2  II. Evidentiary Tables (Articles Reviewed in 2011/2012)………………………….…………24  III. Evidentiary Tables (Articles Reviewed for 2007 Guideline Version)……………..155   

 

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I.  Literature Search Parameters (1990 – June 2011)    Databases Searched:  MEDLINE (PubMed)  ACP Journal Club  Cochrane Database of Systematic Reviews  Database of Abstracts of Reviews of Effectiveness (DARE)  Cochrane Central Register of Controlled Trials  EMBASE Drugs and Pharmacology  Web of Science    Antibiotic Prophylaxis in Spine Surgery   Search Strategies by Clinical Question    Efficacy  1. For patients undergoing spine surgery, does antibiotic prophylaxis result in decreased infection rates compared to patients who do not  receive prophylaxis?     (((("Spine/surgery"[MeSH] OR "Spinal Injuries/surgery"[MeSH] OR "Spinal Diseases/surgery"[MeSH] OR "Spinal Cord/surgery"[MeSH] OR  "Spinal Cord Diseases/surgery"[MeSH] OR "Spinal Fusion"[MeSH] OR "Laminectomy"[MeSH] OR "Diskectomy"[MeSH] OR  ("vertebroplasty"[MeSH Terms] OR "vertebroplasty"[All Fields]) OR ("kyphoplasty"[MeSH Terms] OR "kyphoplasty"[All Fields]) OR spinal  surgery[All Fields] OR spine surgery[All Fields]) AND ("Antibiotic Prophylaxis"[MeSH] OR ("Anti‐Bacterial Agents"[MeSH] OR "Anti‐Bacterial  Agents"[Pharmacological Action]) OR "Antibiotic Prophylaxis"[All Fields])) NOT ("child"[MeSH Terms] OR "child"[All Fields])) OR  ((("Spine/surgery"[MeSH] OR "Spinal Injuries/surgery"[MeSH] OR "Spinal Diseases/surgery"[MeSH] OR "Spinal Cord/surgery"[MeSH] OR  "Spinal Cord Diseases/surgery"[MeSH] OR "Spinal Fusion"[MeSH] OR "Laminectomy"[MeSH] OR "Diskectomy"[MeSH] OR  ("vertebroplasty"[MeSH Terms] OR "vertebroplasty"[All Fields]) OR ("kyphoplasty"[MeSH Terms] OR "kyphoplasty"[All Fields]) OR spinal  surgery[All Fields] OR spine surgery[All Fields]) AND ("Antibiotic Prophylaxis"[MeSH] OR ("Anti‐Bacterial Agents"[MeSH] OR "Anti‐Bacterial  Agents"[Pharmacological Action]) OR "Antibiotic Prophylaxis"[All Fields])) NOT ((("Spine/surgery"[MeSH] OR "Spinal Injuries/surgery"[MeSH]  OR "Spinal Diseases/surgery"[MeSH] OR "Spinal Cord/surgery"[MeSH] OR "Spinal Cord Diseases/surgery"[MeSH] OR "Spinal Fusion"[MeSH]  OR "Laminectomy"[MeSH] OR "Diskectomy"[MeSH] OR ("vertebroplasty"[MeSH Terms] OR "vertebroplasty"[All Fields]) OR  ("kyphoplasty"[MeSH Terms] OR "kyphoplasty"[All Fields]) OR spinal surgery[All Fields] OR spine surgery[All Fields]) AND ("Antibiotic 

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Prophylaxis"[MeSH] OR ("Anti‐Bacterial Agents"[MeSH] OR "Anti‐Bacterial Agents"[Pharmacological Action]) OR "Antibiotic Prophylaxis"[All  Fields])) NOT ("child"[MeSH Terms] OR "child"[All Fields])) AND "adult"[MeSH Terms]) AND (English[lang] AND ("1990"[PDAT] :  "3000"[PDAT]))) AND ("Infection"[MeSH] OR "Bacterial Infections"[MeSH] OR (infect[title] OR infecta[title] OR infectability[title] OR  infectable[title] OR infectans[title] OR infectant[title] OR infectants[title] OR infectation[title] OR infectcheck[title] OR infectd[title] OR  infecte[title] OR infectecd[title] OR infectech's[title] OR infected[title] OR infected/acquired[title] OR infected/affected[title] OR  infected/aids[title] OR infected/contaminated[title] OR infected/necrotic[title] OR infected/septic[title] OR infected'[title] OR  infectedith[title] OR infectednaturally[title] OR infectedness[title] OR infectedwith[title] OR infectees[title] OR infectei[title] OR infecti[title]  OR infectibility[title] OR infectible[title] OR infectied[title] OR infecties[title] OR infectieuse[title] OR infectieuses[title] OR  infectimmunology[title] OR infectin[title] OR infecting[title] OR infectins[title] OR infectio[title] OR infectio2[title] OR infectioks[title] OR  infectiologic[title] OR infectiological[title] OR infectiologist[title] OR infectiologist's[title] OR infectiologues[title] OR infectiology[title] OR  infection[title] OR infection/acquired[title] OR infection/aids[title] OR infection/antibiotic[title] OR infection/bacteremia[title] OR  infection/cerebral[title] OR infection/coinfection[title] OR infection/colonisation[title] OR infection/colonisations[title] OR  infection/colonization[title] OR infection/competition[title] OR infection/compression[title] OR infection/coronary[title] OR  infection/disease[title] OR infection/drug[title] OR infection/hiv[title] OR infection/human[title] OR infection/immunity[title] OR  infection/immunization[title] OR infection/inflammation[title] OR infection/inflammations[title] OR infection/irritation[title] OR  infection/multiplicity[title] OR infection/nsaid[title] OR infection/pneumonia[title] OR infection/pneumonitis[title] OR infection/puo[title] OR  infection/reactivation[title] OR infection/reinfection[title] OR infection/replication[title] OR infection/sepsis[title] OR infection/sexually[title]  OR infection/stasis[title] OR infection/suspected[title] OR infection/systemic[title] OR infection/transmission[title] OR  infection/vaginitis[title] OR infection'[title] OR infection's[title] OR infectiona[title] OR infectional[title] OR infectiondouble[title] OR  infectionin[title] OR infectionist[title] OR infectionists[title] OR infectionof[title] OR infections[title] OR infections/a[title] OR  infections/aids[title] OR infections/hiv[title] OR infections/illness[title] OR infections/illnesses[title] OR infections/inflammation[title] OR  infections/phlebitis[title] OR infections/sexually[title] OR infections/world[title] OR infections'[title] OR infections's[title] OR infectionsa[title]  OR infectionscaused[title] OR infectionus[title] OR infectionx[title] OR infectioons[title] OR infectior[title] OR infectiosa[title] OR  infectiosity[title] OR infectiosum[title] OR infectiosus[title] OR infectious[title] OR infectious/inflammatory[title] OR  infectious/noninfectious[title] OR infectious/parasitic[title] OR infectious/toxic[title] OR infectious'[title] OR infectious'disease[title] OR  infectiousallergic[title] OR infectiousness[title] OR infectitious[title] OR infectius[title] OR infective[title] OR infective/inflammatory[title] OR  infective'[title] OR infectiveness[title] OR infectives[title] OR infectivities[title] OR infectivity[title] OR infectivityand[title] OR  infectivityof[title] OR infectivologists[title] OR infectivology[title] OR infectliga[title] OR infecto[title] OR infectoallergic[title] OR  infectobesity[title] OR infectocaryone[title] OR infectoepidemilogic[title] OR infectogenomics[title] OR infectologia[title] OR  infectologist[title] OR infectologist's[title] OR infectologists[title] OR infectology[title] OR infectome[title] OR infectomic[title] OR 

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infectomics[title] OR infecton[title] OR infectons[title] OR infector[title] OR infectoria[title] OR infectors[title] OR infectosome[title] OR  infectous[title] OR infectrons[title] OR infects[title] OR infectueux[title] OR infectus[title] OR infectvac[title]))     2. For patients undergoing spine surgery without spinal implants, does antibiotic prophylaxis result in decreased infection rates compared to  patients who do not receive prophylaxis?    ((((("Spine/surgery"[MeSH] OR "Spinal Injuries/surgery"[MeSH] OR "Spinal Diseases/surgery"[MeSH] OR "Spinal Cord/surgery"[MeSH] OR  "Spinal Cord Diseases/surgery"[MeSH] OR "Spinal Fusion"[MeSH] OR "Laminectomy"[MeSH] OR "Diskectomy"[MeSH] OR  ("vertebroplasty"[MeSH Terms] OR "vertebroplasty"[All Fields]) OR ("kyphoplasty"[MeSH Terms] OR "kyphoplasty"[All Fields]) OR spinal  surgery[All Fields] OR spine surgery[All Fields]) AND ("Antibiotic Prophylaxis"[MeSH] OR ("Anti‐Bacterial Agents"[MeSH] OR "Anti‐Bacterial  Agents"[Pharmacological Action]) OR "Antibiotic Prophylaxis"[All Fields])) NOT ("child"[MeSH Terms] OR "child"[All Fields])) OR  ((("Spine/surgery"[MeSH] OR "Spinal Injuries/surgery"[MeSH] OR "Spinal Diseases/surgery"[MeSH] OR "Spinal Cord/surgery"[MeSH] OR  "Spinal Cord Diseases/surgery"[MeSH] OR "Spinal Fusion"[MeSH] OR "Laminectomy"[MeSH] OR "Diskectomy"[MeSH] OR  ("vertebroplasty"[MeSH Terms] OR "vertebroplasty"[All Fields]) OR ("kyphoplasty"[MeSH Terms] OR "kyphoplasty"[All Fields]) OR spinal  surgery[All Fields] OR spine surgery[All Fields]) AND ("Antibiotic Prophylaxis"[MeSH] OR ("Anti‐Bacterial Agents"[MeSH] OR "Anti‐Bacterial  Agents"[Pharmacological Action]) OR "Antibiotic Prophylaxis"[All Fields])) NOT ((("Spine/surgery"[MeSH] OR "Spinal Injuries/surgery"[MeSH]  OR "Spinal Diseases/surgery"[MeSH] OR "Spinal Cord/surgery"[MeSH] OR "Spinal Cord Diseases/surgery"[MeSH] OR "Spinal Fusion"[MeSH]  OR "Laminectomy"[MeSH] OR "Diskectomy"[MeSH] OR ("vertebroplasty"[MeSH Terms] OR "vertebroplasty"[All Fields]) OR  ("kyphoplasty"[MeSH Terms] OR "kyphoplasty"[All Fields]) OR spinal surgery[All Fields] OR spine surgery[All Fields]) AND ("Antibiotic  Prophylaxis"[MeSH] OR ("Anti‐Bacterial Agents"[MeSH] OR "Anti‐Bacterial Agents"[Pharmacological Action]) OR "Antibiotic Prophylaxis"[All  Fields])) NOT ("child"[MeSH Terms] OR "child"[All Fields])) AND "adult"[MeSH Terms]) AND (English[lang] AND ("1990"[PDAT] :  "3000"[PDAT]))) AND ("Infection"[MeSH] OR "Bacterial Infections"[MeSH] OR (infect[title] OR infecta[title] OR infectability[title] OR  infectable[title] OR infectans[title] OR infectant[title] OR infectants[title] OR infectation[title] OR infectcheck[title] OR infectd[title] OR  infecte[title] OR infectecd[title] OR infectech's[title] OR infected[title] OR infected/acquired[title] OR infected/affected[title] OR  infected/aids[title] OR infected/contaminated[title] OR infected/necrotic[title] OR infected/septic[title] OR infected'[title] OR  infectedith[title] OR infectednaturally[title] OR infectedness[title] OR infectedwith[title] OR infectees[title] OR infectei[title] OR infecti[title]  OR infectibility[title] OR infectible[title] OR infectied[title] OR infecties[title] OR infectieuse[title] OR infectieuses[title] OR  infectimmunology[title] OR infectin[title] OR infecting[title] OR infectins[title] OR infectio[title] OR infectio2[title] OR infectioks[title] OR  infectiologic[title] OR infectiological[title] OR infectiologist[title] OR infectiologist's[title] OR infectiologues[title] OR infectiology[title] OR  infection[title] OR infection/acquired[title] OR infection/aids[title] OR infection/antibiotic[title] OR infection/bacteremia[title] OR  infection/cerebral[title] OR infection/coinfection[title] OR infection/colonisation[title] OR infection/colonisations[title] OR 

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infection/colonization[title] OR infection/competition[title] OR infection/compression[title] OR infection/coronary[title] OR  infection/disease[title] OR infection/drug[title] OR infection/hiv[title] OR infection/human[title] OR infection/immunity[title] OR  infection/immunization[title] OR infection/inflammation[title] OR infection/inflammations[title] OR infection/irritation[title] OR  infection/multiplicity[title] OR infection/nsaid[title] OR infection/pneumonia[title] OR infection/pneumonitis[title] OR infection/puo[title] OR  infection/reactivation[title] OR infection/reinfection[title] OR infection/replication[title] OR infection/sepsis[title] OR infection/sexually[title]  OR infection/stasis[title] OR infection/suspected[title] OR infection/systemic[title] OR infection/transmission[title] OR  infection/vaginitis[title] OR infection'[title] OR infection's[title] OR infectiona[title] OR infectional[title] OR infectiondouble[title] OR  infectionin[title] OR infectionist[title] OR infectionists[title] OR infectionof[title] OR infections[title] OR infections/a[title] OR  infections/aids[title] OR infections/hiv[title] OR infections/illness[title] OR infections/illnesses[title] OR infections/inflammation[title] OR  infections/phlebitis[title] OR infections/sexually[title] OR infections/world[title] OR infections'[title] OR infections's[title] OR infectionsa[title]  OR infectionscaused[title] OR infectionus[title] OR infectionx[title] OR infectioons[title] OR infectior[title] OR infectiosa[title] OR  infectiosity[title] OR infectiosum[title] OR infectiosus[title] OR infectious[title] OR infectious/inflammatory[title] OR  infectious/noninfectious[title] OR infectious/parasitic[title] OR infectious/toxic[title] OR infectious'[title] OR infectious'disease[title] OR  infectiousallergic[title] OR infectiousness[title] OR infectitious[title] OR infectius[title] OR infective[title] OR infective/inflammatory[title] OR  infective'[title] OR infectiveness[title] OR infectives[title] OR infectivities[title] OR infectivity[title] OR infectivityand[title] OR  infectivityof[title] OR infectivologists[title] OR infectivology[title] OR infectliga[title] OR infecto[title] OR infectoallergic[title] OR  infectobesity[title] OR infectocaryone[title] OR infectoepidemilogic[title] OR infectogenomics[title] OR infectologia[title] OR  infectologist[title] OR infectologist's[title] OR infectologists[title] OR infectology[title] OR infectome[title] OR infectomic[title] OR  infectomics[title] OR infecton[title] OR infectons[title] OR infector[title] OR infectoria[title] OR infectors[title] OR infectosome[title] OR  infectous[title] OR infectrons[title] OR infects[title] OR infectueux[title] OR infectus[title] OR infectvac[title]))) NOT ("Prostheses and  Implants"[MeSH] OR "Prosthesis Implantation"[MeSH] OR "instrumentation"[Subheading] OR instrumentation[title] OR (implant[title] OR  implant/abutment[title] OR implant/allograft[title] OR implant/bar[title] OR implant/bone[title] OR implant/cement[title] OR  implant/component[title] OR implant/deaf[title] OR implant/framework[title] OR implant/host[title] OR implant/jawbone[title] OR  implant/mri[title] OR implant/multiple[title] OR implant/natural[title] OR implant/overdenture[title] OR implant/prosthesis[title] OR  implant/restorative[title] OR implant/retaining[title] OR implant/schwamm[title] OR implant/soft[title] OR implant/tissue[title] OR  implant/tooth[title] OR implant/tympanic[title] OR implant/ucla[title] OR implant'[title] OR implant's[title] OR implantability[title] OR  implantable[title] OR implantables[title] OR implantacji[title] OR implantal[title] OR implantantation[title] OR implantar[title] OR  implantary[title] OR implantatation[title] OR implantate[title] OR implantaten[title] OR implantates[title] OR implantatiion[title] OR  implantatin[title] OR implantating[title] OR implantation[title] OR implantation/growth[title] OR implantation/prevascularization[title] OR  implantation/revision[title] OR implantation'[title] OR implantational[title] OR implantationing[title] OR implantations[title] OR  implantative[title] OR implantatology[title] OR implantaton[title] OR implantatoon[title] OR implantatory[title] OR implante[title] OR 

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implantectomy[title] OR implantectomy/capsulectomy[title] OR implanted[title] OR implantee[title] OR implantees[title] OR  implantees'[title] OR implanter[title] OR implanters[title] OR implantes[title] OR implantible[title] OR implantin[title] OR implanting[title] OR  implanting'[title] OR implantion[title] OR implantitis[title] OR implantive[title] OR implanto[title] OR implantoclasia[title] OR  implantodontics[title] OR implantodontist[title] OR implantodontists[title] OR implantofix[title] OR implantogingival[title] OR  implantologia[title] OR implantologic[title] OR implantological[title] OR implantologicum[title] OR implantologie[title] OR  implantologist[title] OR implantologists[title] OR implantology[title] OR implantology's[title] OR implantomania[title] OR  implantometer[title] OR implantoplasty[title] OR implantor[title] OR implantoral[title] OR implantorama[title] OR implants[title] OR  implants'[title] OR implantsin[title] OR implantsusing[title] OR implanttion[title] OR implantvision[title]) OR "Orthopedic Fixation  Devices"[MeSH] OR "vertebroplasty"[MeSH Terms] OR "kyphoplasty"[MeSH Terms])    3. For patients undergoing spine surgery with spinal implants, does antibiotic prophylaxis result in decreased infection rates compared to  patients who do not receive prophylaxis?  ((((("Spine/surgery"[MeSH] OR "Spinal Injuries/surgery"[MeSH] OR "Spinal Diseases/surgery"[MeSH] OR "Spinal Cord/surgery"[MeSH] OR  "Spinal Cord Diseases/surgery"[MeSH] OR "Spinal Fusion"[MeSH] OR "Laminectomy"[MeSH] OR "Diskectomy"[MeSH] OR  ("vertebroplasty"[MeSH Terms] OR "vertebroplasty"[All Fields]) OR ("kyphoplasty"[MeSH Terms] OR "kyphoplasty"[All Fields]) OR spinal  surgery[All Fields] OR spine surgery[All Fields]) AND ("Antibiotic Prophylaxis"[MeSH] OR ("Anti‐Bacterial Agents"[MeSH] OR "Anti‐Bacterial  Agents"[Pharmacological Action]) OR "Antibiotic Prophylaxis"[All Fields])) NOT ("child"[MeSH Terms] OR "child"[All Fields])) OR  ((("Spine/surgery"[MeSH] OR "Spinal Injuries/surgery"[MeSH] OR "Spinal Diseases/surgery"[MeSH] OR "Spinal Cord/surgery"[MeSH] OR  "Spinal Cord Diseases/surgery"[MeSH] OR "Spinal Fusion"[MeSH] OR "Laminectomy"[MeSH] OR "Diskectomy"[MeSH] OR  ("vertebroplasty"[MeSH Terms] OR "vertebroplasty"[All Fields]) OR ("kyphoplasty"[MeSH Terms] OR "kyphoplasty"[All Fields]) OR spinal  surgery[All Fields] OR spine surgery[All Fields]) AND ("Antibiotic Prophylaxis"[MeSH] OR ("Anti‐Bacterial Agents"[MeSH] OR "Anti‐Bacterial  Agents"[Pharmacological Action]) OR "Antibiotic Prophylaxis"[All Fields])) NOT ((("Spine/surgery"[MeSH] OR "Spinal Injuries/surgery"[MeSH]  OR "Spinal Diseases/surgery"[MeSH] OR "Spinal Cord/surgery"[MeSH] OR "Spinal Cord Diseases/surgery"[MeSH] OR "Spinal Fusion"[MeSH]  OR "Laminectomy"[MeSH] OR "Diskectomy"[MeSH] OR ("vertebroplasty"[MeSH Terms] OR "vertebroplasty"[All Fields]) OR  ("kyphoplasty"[MeSH Terms] OR "kyphoplasty"[All Fields]) OR spinal surgery[All Fields] OR spine surgery[All Fields]) AND ("Antibiotic  Prophylaxis"[MeSH] OR ("Anti‐Bacterial Agents"[MeSH] OR "Anti‐Bacterial Agents"[Pharmacological Action]) OR "Antibiotic Prophylaxis"[All  Fields])) NOT ("child"[MeSH Terms] OR "child"[All Fields])) AND "adult"[MeSH Terms]) AND (English[lang] AND ("1990"[PDAT] :  "3000"[PDAT]))) AND ("Infection"[MeSH] OR "Bacterial Infections"[MeSH] OR (infect[title] OR infecta[title] OR infectability[title] OR  infectable[title] OR infectans[title] OR infectant[title] OR infectants[title] OR infectation[title] OR infectcheck[title] OR infectd[title] OR  infecte[title] OR infectecd[title] OR infectech's[title] OR infected[title] OR infected/acquired[title] OR infected/affected[title] OR  infected/aids[title] OR infected/contaminated[title] OR infected/necrotic[title] OR infected/septic[title] OR infected'[title] OR 

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infectedith[title] OR infectednaturally[title] OR infectedness[title] OR infectedwith[title] OR infectees[title] OR infectei[title] OR infecti[title]  OR infectibility[title] OR infectible[title] OR infectied[title] OR infecties[title] OR infectieuse[title] OR infectieuses[title] OR  infectimmunology[title] OR infectin[title] OR infecting[title] OR infectins[title] OR infectio[title] OR infectio2[title] OR infectioks[title] OR  infectiologic[title] OR infectiological[title] OR infectiologist[title] OR infectiologist's[title] OR infectiologues[title] OR infectiology[title] OR  infection[title] OR infection/acquired[title] OR infection/aids[title] OR infection/antibiotic[title] OR infection/bacteremia[title] OR  infection/cerebral[title] OR infection/coinfection[title] OR infection/colonisation[title] OR infection/colonisations[title] OR  infection/colonization[title] OR infection/competition[title] OR infection/compression[title] OR infection/coronary[title] OR  infection/disease[title] OR infection/drug[title] OR infection/hiv[title] OR infection/human[title] OR infection/immunity[title] OR  infection/immunization[title] OR infection/inflammation[title] OR infection/inflammations[title] OR infection/irritation[title] OR  infection/multiplicity[title] OR infection/nsaid[title] OR infection/pneumonia[title] OR infection/pneumonitis[title] OR infection/puo[title] OR  infection/reactivation[title] OR infection/reinfection[title] OR infection/replication[title] OR infection/sepsis[title] OR infection/sexually[title]  OR infection/stasis[title] OR infection/suspected[title] OR infection/systemic[title] OR infection/transmission[title] OR  infection/vaginitis[title] OR infection'[title] OR infection's[title] OR infectiona[title] OR infectional[title] OR infectiondouble[title] OR  infectionin[title] OR infectionist[title] OR infectionists[title] OR infectionof[title] OR infections[title] OR infections/a[title] OR  infections/aids[title] OR infections/hiv[title] OR infections/illness[title] OR infections/illnesses[title] OR infections/inflammation[title] OR  infections/phlebitis[title] OR infections/sexually[title] OR infections/world[title] OR infections'[title] OR infections's[title] OR infectionsa[title]  OR infectionscaused[title] OR infectionus[title] OR infectionx[title] OR infectioons[title] OR infectior[title] OR infectiosa[title] OR  infectiosity[title] OR infectiosum[title] OR infectiosus[title] OR infectious[title] OR infectious/inflammatory[title] OR  infectious/noninfectious[title] OR infectious/parasitic[title] OR infectious/toxic[title] OR infectious'[title] OR infectious'disease[title] OR  infectiousallergic[title] OR infectiousness[title] OR infectitious[title] OR infectius[title] OR infective[title] OR infective/inflammatory[title] OR  infective'[title] OR infectiveness[title] OR infectives[title] OR infectivities[title] OR infectivity[title] OR infectivityand[title] OR  infectivityof[title] OR infectivologists[title] OR infectivology[title] OR infectliga[title] OR infecto[title] OR infectoallergic[title] OR  infectobesity[title] OR infectocaryone[title] OR infectoepidemilogic[title] OR infectogenomics[title] OR infectologia[title] OR  infectologist[title] OR infectologist's[title] OR infectologists[title] OR infectology[title] OR infectome[title] OR infectomic[title] OR  infectomics[title] OR infecton[title] OR infectons[title] OR infector[title] OR infectoria[title] OR infectors[title] OR infectosome[title] OR  infectous[title] OR infectrons[title] OR infects[title] OR infectueux[title] OR infectus[title] OR infectvac[title]))) AND ("Prostheses and  Implants"[MeSH] OR "Prosthesis Implantation"[MeSH] OR "instrumentation"[Subheading] OR instrumentation[title] OR (implant[title] OR  implant/abutment[title] OR implant/allograft[title] OR implant/bar[title] OR implant/bone[title] OR implant/cement[title] OR  implant/component[title] OR implant/deaf[title] OR implant/framework[title] OR implant/host[title] OR implant/jawbone[title] OR  implant/mri[title] OR implant/multiple[title] OR implant/natural[title] OR implant/overdenture[title] OR implant/prosthesis[title] OR  implant/restorative[title] OR implant/retaining[title] OR implant/schwamm[title] OR implant/soft[title] OR implant/tissue[title] OR 

7

implant/tooth[title] OR implant/tympanic[title] OR implant/ucla[title] OR implant'[title] OR implant's[title] OR implantability[title] OR  implantable[title] OR implantables[title] OR implantacji[title] OR implantal[title] OR implantantation[title] OR implantar[title] OR  implantary[title] OR implantatation[title] OR implantate[title] OR implantaten[title] OR implantates[title] OR implantatiion[title] OR  implantatin[title] OR implantating[title] OR implantation[title] OR implantation/growth[title] OR implantation/prevascularization[title] OR  implantation/revision[title] OR implantation'[title] OR implantational[title] OR implantationing[title] OR implantations[title] OR  implantative[title] OR implantatology[title] OR implantaton[title] OR implantatoon[title] OR implantatory[title] OR implante[title] OR  implantectomy[title] OR implantectomy/capsulectomy[title] OR implanted[title] OR implantee[title] OR implantees[title] OR  implantees'[title] OR implanter[title] OR implanters[title] OR implantes[title] OR implantible[title] OR implantin[title] OR implanting[title] OR  implanting'[title] OR implantion[title] OR implantitis[title] OR implantive[title] OR implanto[title] OR implantoclasia[title] OR  implantodontics[title] OR implantodontist[title] OR implantodontists[title] OR implantofix[title] OR implantogingival[title] OR  implantologia[title] OR implantologic[title] OR implantological[title] OR implantologicum[title] OR implantologie[title] OR  implantologist[title] OR implantologists[title] OR implantology[title] OR implantology's[title] OR implantomania[title] OR  implantometer[title] OR implantoplasty[title] OR implantor[title] OR implantoral[title] OR implantorama[title] OR implants[title] OR  implants'[title] OR implantsin[title] OR implantsusing[title] OR implanttion[title] OR implantvision[title]) OR "Orthopedic Fixation  Devices"[MeSH] OR "vertebroplasty"[MeSH Terms] OR "kyphoplasty"[MeSH Terms])    4. What rate of surgical site infections can be expected with the use of antibiotic prophylaxis, considering both patients with and patients  without medical comorbidities?  With Co‐Morbidities  ((((("Spine/surgery"[MeSH] OR "Spinal Injuries/surgery"[MeSH] OR "Spinal Diseases/surgery"[MeSH] OR "Spinal Cord/surgery"[MeSH] OR  "Spinal Cord Diseases/surgery"[MeSH] OR "Spinal Fusion"[MeSH] OR "Laminectomy"[MeSH] OR "Diskectomy"[MeSH] OR  ("vertebroplasty"[MeSH Terms] OR "vertebroplasty"[All Fields]) OR ("kyphoplasty"[MeSH Terms] OR "kyphoplasty"[All Fields]) OR spinal  surgery[All Fields] OR spine surgery[All Fields]) AND ("Antibiotic Prophylaxis"[MeSH] OR ("Anti‐Bacterial Agents"[MeSH] OR "Anti‐Bacterial  Agents"[Pharmacological Action]) OR "Antibiotic Prophylaxis"[All Fields])) NOT ("child"[MeSH Terms] OR "child"[All Fields])) OR  ((("Spine/surgery"[MeSH] OR "Spinal Injuries/surgery"[MeSH] OR "Spinal Diseases/surgery"[MeSH] OR "Spinal Cord/surgery"[MeSH] OR  "Spinal Cord Diseases/surgery"[MeSH] OR "Spinal Fusion"[MeSH] OR "Laminectomy"[MeSH] OR "Diskectomy"[MeSH] OR  ("vertebroplasty"[MeSH Terms] OR "vertebroplasty"[All Fields]) OR ("kyphoplasty"[MeSH Terms] OR "kyphoplasty"[All Fields]) OR spinal  surgery[All Fields] OR spine surgery[All Fields]) AND ("Antibiotic Prophylaxis"[MeSH] OR ("Anti‐Bacterial Agents"[MeSH] OR "Anti‐Bacterial  Agents"[Pharmacological Action]) OR "Antibiotic Prophylaxis"[All Fields])) NOT ((("Spine/surgery"[MeSH] OR "Spinal Injuries/surgery"[MeSH]  OR "Spinal Diseases/surgery"[MeSH] OR "Spinal Cord/surgery"[MeSH] OR "Spinal Cord Diseases/surgery"[MeSH] OR "Spinal Fusion"[MeSH]  OR "Laminectomy"[MeSH] OR "Diskectomy"[MeSH] OR ("vertebroplasty"[MeSH Terms] OR "vertebroplasty"[All Fields]) OR 

8

("kyphoplasty"[MeSH Terms] OR "kyphoplasty"[All Fields]) OR spinal surgery[All Fields] OR spine surgery[All Fields]) AND ("Antibiotic  Prophylaxis"[MeSH] OR ("Anti‐Bacterial Agents"[MeSH] OR "Anti‐Bacterial Agents"[Pharmacological Action]) OR "Antibiotic Prophylaxis"[All  Fields])) NOT ("child"[MeSH Terms] OR "child"[All Fields])) AND "adult"[MeSH Terms]) AND (English[lang] AND ("1990"[PDAT] :  "3000"[PDAT]))) AND "Surgical Wound Infection"[Mesh]) AND ("Comorbidity"[MeSH] OR "Diabetes Mellitus"[MeSH] OR "Smoking"[MeSH]  OR "Nutrition Disorders"[MeSH] OR "Immunologic Deficiency Syndromes"[MeSH] OR "Immunocompromised Host"[MeSH] OR  (comorbidities[title] OR comorbiditiy[title] OR comorbidity[title] OR comorbidity/cosyndromality[title] OR comorbidity/overlapping[title] OR  comorbidity'[title]))    Without Comorbidities  (((("Spine/surgery"[MeSH] OR "Spinal Injuries/surgery"[MeSH] OR "Spinal Diseases/surgery"[MeSH] OR "Spinal Cord/surgery"[MeSH] OR  "Spinal Cord Diseases/surgery"[MeSH] OR "Spinal Fusion"[MeSH] OR "Laminectomy"[MeSH] OR "Diskectomy"[MeSH] OR  ("vertebroplasty"[MeSH Terms] OR "vertebroplasty"[All Fields]) OR ("kyphoplasty"[MeSH Terms] OR "kyphoplasty"[All Fields]) OR spinal  surgery[All Fields] OR spine surgery[All Fields]) AND ("Antibiotic Prophylaxis"[MeSH] OR ("Anti‐Bacterial Agents"[MeSH] OR "Anti‐Bacterial  Agents"[Pharmacological Action]) OR "Antibiotic Prophylaxis"[All Fields])) NOT ("child"[MeSH Terms] OR "child"[All Fields])) OR  ((("Spine/surgery"[MeSH] OR "Spinal Injuries/surgery"[MeSH] OR "Spinal Diseases/surgery"[MeSH] OR "Spinal Cord/surgery"[MeSH] OR  "Spinal Cord Diseases/surgery"[MeSH] OR "Spinal Fusion"[MeSH] OR "Laminectomy"[MeSH] OR "Diskectomy"[MeSH] OR  ("vertebroplasty"[MeSH Terms] OR "vertebroplasty"[All Fields]) OR ("kyphoplasty"[MeSH Terms] OR "kyphoplasty"[All Fields]) OR spinal  surgery[All Fields] OR spine surgery[All Fields]) AND ("Antibiotic Prophylaxis"[MeSH] OR ("Anti‐Bacterial Agents"[MeSH] OR "Anti‐Bacterial  Agents"[Pharmacological Action]) OR "Antibiotic Prophylaxis"[All Fields])) NOT ((("Spine/surgery"[MeSH] OR "Spinal Injuries/surgery"[MeSH]  OR "Spinal Diseases/surgery"[MeSH] OR "Spinal Cord/surgery"[MeSH] OR "Spinal Cord Diseases/surgery"[MeSH] OR "Spinal Fusion"[MeSH]  OR "Laminectomy"[MeSH] OR "Diskectomy"[MeSH] OR ("vertebroplasty"[MeSH Terms] OR "vertebroplasty"[All Fields]) OR  ("kyphoplasty"[MeSH Terms] OR "kyphoplasty"[All Fields]) OR spinal surgery[All Fields] OR spine surgery[All Fields]) AND ("Antibiotic  Prophylaxis"[MeSH] OR ("Anti‐Bacterial Agents"[MeSH] OR "Anti‐Bacterial Agents"[Pharmacological Action]) OR "Antibiotic Prophylaxis"[All  Fields])) NOT ("child"[MeSH Terms] OR "child"[All Fields])) AND "adult"[MeSH Terms]) AND (English[lang] AND ("1990"[PDAT] :  "3000"[PDAT]))) AND "Surgical Wound Infection"[Mesh]    Protocol  5. For patients receiving antibiotic prophylaxis prior to spine surgery, what are the recommended drugs, their dosages, routes of administration  and time of administration resulting in decreased postoperative infection rates?  ((((("Spine/surgery"[MeSH] OR "Spinal Injuries/surgery"[MeSH] OR "Spinal Diseases/surgery"[MeSH] OR "Spinal Cord/surgery"[MeSH] OR  "Spinal Cord Diseases/surgery"[MeSH] OR "Spinal Fusion"[MeSH] OR "Laminectomy"[MeSH] OR "Diskectomy"[MeSH] OR 

9

("vertebroplasty"[MeSH Terms] OR "vertebroplasty"[All Fields]) OR ("kyphoplasty"[MeSH Terms] OR "kyphoplasty"[All Fields]) OR spinal  surgery[All Fields] OR spine surgery[All Fields]) AND ("Antibiotic Prophylaxis"[MeSH] OR ("Anti‐Bacterial Agents"[MeSH] OR "Anti‐Bacterial  Agents"[Pharmacological Action]) OR "Antibiotic Prophylaxis"[All Fields])) NOT ("child"[MeSH Terms] OR "child"[All Fields])) OR  ((("Spine/surgery"[MeSH] OR "Spinal Injuries/surgery"[MeSH] OR "Spinal Diseases/surgery"[MeSH] OR "Spinal Cord/surgery"[MeSH] OR  "Spinal Cord Diseases/surgery"[MeSH] OR "Spinal Fusion"[MeSH] OR "Laminectomy"[MeSH] OR "Diskectomy"[MeSH] OR  ("vertebroplasty"[MeSH Terms] OR "vertebroplasty"[All Fields]) OR ("kyphoplasty"[MeSH Terms] OR "kyphoplasty"[All Fields]) OR spinal  surgery[All Fields] OR spine surgery[All Fields]) AND ("Antibiotic Prophylaxis"[MeSH] OR ("Anti‐Bacterial Agents"[MeSH] OR "Anti‐Bacterial  Agents"[Pharmacological Action]) OR "Antibiotic Prophylaxis"[All Fields])) NOT ((("Spine/surgery"[MeSH] OR "Spinal Injuries/surgery"[MeSH]  OR "Spinal Diseases/surgery"[MeSH] OR "Spinal Cord/surgery"[MeSH] OR "Spinal Cord Diseases/surgery"[MeSH] OR "Spinal Fusion"[MeSH]  OR "Laminectomy"[MeSH] OR "Diskectomy"[MeSH] OR ("vertebroplasty"[MeSH Terms] OR "vertebroplasty"[All Fields]) OR  ("kyphoplasty"[MeSH Terms] OR "kyphoplasty"[All Fields]) OR spinal surgery[All Fields] OR spine surgery[All Fields]) AND ("Antibiotic  Prophylaxis"[MeSH] OR ("Anti‐Bacterial Agents"[MeSH] OR "Anti‐Bacterial Agents"[Pharmacological Action]) OR "Antibiotic Prophylaxis"[All  Fields])) NOT ("child"[MeSH Terms] OR "child"[All Fields])) AND "adult"[MeSH Terms]) AND (English[lang] AND ("1990"[PDAT] :  "3000"[PDAT]))) AND ("Infection"[MeSH] OR "Bacterial Infections"[MeSH] OR (infect[title] OR infecta[title] OR infectability[title] OR  infectable[title] OR infectans[title] OR infectant[title] OR infectants[title] OR infectation[title] OR infectcheck[title] OR infectd[title] OR  infecte[title] OR infectecd[title] OR infectech's[title] OR infected[title] OR infected/acquired[title] OR infected/affected[title] OR  infected/aids[title] OR infected/contaminated[title] OR infected/necrotic[title] OR infected/septic[title] OR infected'[title] OR  infectedith[title] OR infectednaturally[title] OR infectedness[title] OR infectedwith[title] OR infectees[title] OR infectei[title] OR infecti[title]  OR infectibility[title] OR infectible[title] OR infectied[title] OR infecties[title] OR infectieuse[title] OR infectieuses[title] OR  infectimmunology[title] OR infectin[title] OR infecting[title] OR infectins[title] OR infectio[title] OR infectio2[title] OR infectioks[title] OR  infectiologic[title] OR infectiological[title] OR infectiologist[title] OR infectiologist's[title] OR infectiologues[title] OR infectiology[title] OR  infection[title] OR infection/acquired[title] OR infection/aids[title] OR infection/antibiotic[title] OR infection/bacteremia[title] OR  infection/cerebral[title] OR infection/coinfection[title] OR infection/colonisation[title] OR infection/colonisations[title] OR  infection/colonization[title] OR infection/competition[title] OR infection/compression[title] OR infection/coronary[title] OR  infection/disease[title] OR infection/drug[title] OR infection/hiv[title] OR infection/human[title] OR infection/immunity[title] OR  infection/immunization[title] OR infection/inflammation[title] OR infection/inflammations[title] OR infection/irritation[title] OR  infection/multiplicity[title] OR infection/nsaid[title] OR infection/pneumonia[title] OR infection/pneumonitis[title] OR infection/puo[title] OR  infection/reactivation[title] OR infection/reinfection[title] OR infection/replication[title] OR infection/sepsis[title] OR infection/sexually[title]  OR infection/stasis[title] OR infection/suspected[title] OR infection/systemic[title] OR infection/transmission[title] OR  infection/vaginitis[title] OR infection'[title] OR infection's[title] OR infectiona[title] OR infectional[title] OR infectiondouble[title] OR  infectionin[title] OR infectionist[title] OR infectionists[title] OR infectionof[title] OR infections[title] OR infections/a[title] OR 

10

infections/aids[title] OR infections/hiv[title] OR infections/illness[title] OR infections/illnesses[title] OR infections/inflammation[title] OR  infections/phlebitis[title] OR infections/sexually[title] OR infections/world[title] OR infections'[title] OR infections's[title] OR infectionsa[title]  OR infectionscaused[title] OR infectionus[title] OR infectionx[title] OR infectioons[title] OR infectior[title] OR infectiosa[title] OR  infectiosity[title] OR infectiosum[title] OR infectiosus[title] OR infectious[title] OR infectious/inflammatory[title] OR  infectious/noninfectious[title] OR infectious/parasitic[title] OR infectious/toxic[title] OR infectious'[title] OR infectious'disease[title] OR  infectiousallergic[title] OR infectiousness[title] OR infectitious[title] OR infectius[title] OR infective[title] OR infective/inflammatory[title] OR  infective'[title] OR infectiveness[title] OR infectives[title] OR infectivities[title] OR infectivity[title] OR infectivityand[title] OR  infectivityof[title] OR infectivologists[title] OR infectivology[title] OR infectliga[title] OR infecto[title] OR infectoallergic[title] OR  infectobesity[title] OR infectocaryone[title] OR infectoepidemilogic[title] OR infectogenomics[title] OR infectologia[title] OR  infectologist[title] OR infectologist's[title] OR infectologists[title] OR infectology[title] OR infectome[title] OR infectomic[title] OR  infectomics[title] OR infecton[title] OR infectons[title] OR infector[title] OR infectoria[title] OR infectors[title] OR infectosome[title] OR  infectous[title] OR infectrons[title] OR infects[title] OR infectueux[title] OR infectus[title] OR infectvac[title]))) AND ("administration and  dosage"[Subheading] OR "Drug Administration Schedule"[MeSH] OR "Drug Therapy"[MeSH] OR "drug therapy"[Subheading])    6. For patients receiving antibiotic prophylaxis prior to spine surgery without spinal implants, what are the recommended drugs, their dosages,  routes of administration and time of administration resulting in decreased postoperative infection rates?  (((((("Spine/surgery"[MeSH] OR "Spinal Injuries/surgery"[MeSH] OR "Spinal Diseases/surgery"[MeSH] OR "Spinal Cord/surgery"[MeSH] OR  "Spinal Cord Diseases/surgery"[MeSH] OR "Spinal Fusion"[MeSH] OR "Laminectomy"[MeSH] OR "Diskectomy"[MeSH] OR  ("vertebroplasty"[MeSH Terms] OR "vertebroplasty"[All Fields]) OR ("kyphoplasty"[MeSH Terms] OR "kyphoplasty"[All Fields]) OR spinal  surgery[All Fields] OR spine surgery[All Fields]) AND ("Antibiotic Prophylaxis"[MeSH] OR ("Anti‐Bacterial Agents"[MeSH] OR "Anti‐Bacterial  Agents"[Pharmacological Action]) OR "Antibiotic Prophylaxis"[All Fields])) NOT ("child"[MeSH Terms] OR "child"[All Fields])) OR  ((("Spine/surgery"[MeSH] OR "Spinal Injuries/surgery"[MeSH] OR "Spinal Diseases/surgery"[MeSH] OR "Spinal Cord/surgery"[MeSH] OR  "Spinal Cord Diseases/surgery"[MeSH] OR "Spinal Fusion"[MeSH] OR "Laminectomy"[MeSH] OR "Diskectomy"[MeSH] OR  ("vertebroplasty"[MeSH Terms] OR "vertebroplasty"[All Fields]) OR ("kyphoplasty"[MeSH Terms] OR "kyphoplasty"[All Fields]) OR spinal  surgery[All Fields] OR spine surgery[All Fields]) AND ("Antibiotic Prophylaxis"[MeSH] OR ("Anti‐Bacterial Agents"[MeSH] OR "Anti‐Bacterial  Agents"[Pharmacological Action]) OR "Antibiotic Prophylaxis"[All Fields])) NOT ((("Spine/surgery"[MeSH] OR "Spinal Injuries/surgery"[MeSH]  OR "Spinal Diseases/surgery"[MeSH] OR "Spinal Cord/surgery"[MeSH] OR "Spinal Cord Diseases/surgery"[MeSH] OR "Spinal Fusion"[MeSH]  OR "Laminectomy"[MeSH] OR "Diskectomy"[MeSH] OR ("vertebroplasty"[MeSH Terms] OR "vertebroplasty"[All Fields]) OR  ("kyphoplasty"[MeSH Terms] OR "kyphoplasty"[All Fields]) OR spinal surgery[All Fields] OR spine surgery[All Fields]) AND ("Antibiotic  Prophylaxis"[MeSH] OR ("Anti‐Bacterial Agents"[MeSH] OR "Anti‐Bacterial Agents"[Pharmacological Action]) OR "Antibiotic Prophylaxis"[All  Fields])) NOT ("child"[MeSH Terms] OR "child"[All Fields])) AND "adult"[MeSH Terms]) AND (English[lang] AND ("1990"[PDAT] : 

11

"3000"[PDAT]))) AND ("Infection"[MeSH] OR "Bacterial Infections"[MeSH] OR (infect[title] OR infecta[title] OR infectability[title] OR  infectable[title] OR infectans[title] OR infectant[title] OR infectants[title] OR infectation[title] OR infectcheck[title] OR infectd[title] OR  infecte[title] OR infectecd[title] OR infectech's[title] OR infected[title] OR infected/acquired[title] OR infected/affected[title] OR  infected/aids[title] OR infected/contaminated[title] OR infected/necrotic[title] OR infected/septic[title] OR infected'[title] OR  infectedith[title] OR infectednaturally[title] OR infectedness[title] OR infectedwith[title] OR infectees[title] OR infectei[title] OR infecti[title]  OR infectibility[title] OR infectible[title] OR infectied[title] OR infecties[title] OR infectieuse[title] OR infectieuses[title] OR  infectimmunology[title] OR infectin[title] OR infecting[title] OR infectins[title] OR infectio[title] OR infectio2[title] OR infectioks[title] OR  infectiologic[title] OR infectiological[title] OR infectiologist[title] OR infectiologist's[title] OR infectiologues[title] OR infectiology[title] OR  infection[title] OR infection/acquired[title] OR infection/aids[title] OR infection/antibiotic[title] OR infection/bacteremia[title] OR  infection/cerebral[title] OR infection/coinfection[title] OR infection/colonisation[title] OR infection/colonisations[title] OR  infection/colonization[title] OR infection/competition[title] OR infection/compression[title] OR infection/coronary[title] OR  infection/disease[title] OR infection/drug[title] OR infection/hiv[title] OR infection/human[title] OR infection/immunity[title] OR  infection/immunization[title] OR infection/inflammation[title] OR infection/inflammations[title] OR infection/irritation[title] OR  infection/multiplicity[title] OR infection/nsaid[title] OR infection/pneumonia[title] OR infection/pneumonitis[title] OR infection/puo[title] OR  infection/reactivation[title] OR infection/reinfection[title] OR infection/replication[title] OR infection/sepsis[title] OR infection/sexually[title]  OR infection/stasis[title] OR infection/suspected[title] OR infection/systemic[title] OR infection/transmission[title] OR  infection/vaginitis[title] OR infection'[title] OR infection's[title] OR infectiona[title] OR infectional[title] OR infectiondouble[title] OR  infectionin[title] OR infectionist[title] OR infectionists[title] OR infectionof[title] OR infections[title] OR infections/a[title] OR  infections/aids[title] OR infections/hiv[title] OR infections/illness[title] OR infections/illnesses[title] OR infections/inflammation[title] OR  infections/phlebitis[title] OR infections/sexually[title] OR infections/world[title] OR infections'[title] OR infections's[title] OR infectionsa[title]  OR infectionscaused[title] OR infectionus[title] OR infectionx[title] OR infectioons[title] OR infectior[title] OR infectiosa[title] OR  infectiosity[title] OR infectiosum[title] OR infectiosus[title] OR infectious[title] OR infectious/inflammatory[title] OR  infectious/noninfectious[title] OR infectious/parasitic[title] OR infectious/toxic[title] OR infectious'[title] OR infectious'disease[title] OR  infectiousallergic[title] OR infectiousness[title] OR infectitious[title] OR infectius[title] OR infective[title] OR infective/inflammatory[title] OR  infective'[title] OR infectiveness[title] OR infectives[title] OR infectivities[title] OR infectivity[title] OR infectivityand[title] OR  infectivityof[title] OR infectivologists[title] OR infectivology[title] OR infectliga[title] OR infecto[title] OR infectoallergic[title] OR  infectobesity[title] OR infectocaryone[title] OR infectoepidemilogic[title] OR infectogenomics[title] OR infectologia[title] OR  infectologist[title] OR infectologist's[title] OR infectologists[title] OR infectology[title] OR infectome[title] OR infectomic[title] OR  infectomics[title] OR infecton[title] OR infectons[title] OR infector[title] OR infectoria[title] OR infectors[title] OR infectosome[title] OR  infectous[title] OR infectrons[title] OR infects[title] OR infectueux[title] OR infectus[title] OR infectvac[title]))) AND ("administration and  dosage"[Subheading] OR "Drug Administration Schedule"[MeSH] OR "Drug Therapy"[MeSH] OR "drug therapy"[Subheading])) NOT 

12

("Prostheses and Implants"[MeSH] OR "Prosthesis Implantation"[MeSH] OR "instrumentation"[Subheading] OR instrumentation[title] OR  "Orthopedic Fixation Devices"[MeSH] OR ("vertebroplasty"[MeSH Terms] OR "vertebroplasty"[All Fields]) OR ("kyphoplasty"[MeSH Terms]  OR "kyphoplasty"[All Fields]))    7. For patients receiving antibiotic prophylaxis prior to spine surgery with spinal implants, what are the recommended drugs, their dosages,  routes of administration and time of administration resulting in decreased postoperative infection rates?  (((((("Spine/surgery"[MeSH] OR "Spinal Injuries/surgery"[MeSH] OR "Spinal Diseases/surgery"[MeSH] OR "Spinal Cord/surgery"[MeSH] OR  "Spinal Cord Diseases/surgery"[MeSH] OR "Spinal Fusion"[MeSH] OR "Laminectomy"[MeSH] OR "Diskectomy"[MeSH] OR  ("vertebroplasty"[MeSH Terms] OR "vertebroplasty"[All Fields]) OR ("kyphoplasty"[MeSH Terms] OR "kyphoplasty"[All Fields]) OR spinal  surgery[All Fields] OR spine surgery[All Fields]) AND ("Antibiotic Prophylaxis"[MeSH] OR ("Anti‐Bacterial Agents"[MeSH] OR "Anti‐Bacterial  Agents"[Pharmacological Action]) OR "Antibiotic Prophylaxis"[All Fields])) NOT ("child"[MeSH Terms] OR "child"[All Fields])) OR  ((("Spine/surgery"[MeSH] OR "Spinal Injuries/surgery"[MeSH] OR "Spinal Diseases/surgery"[MeSH] OR "Spinal Cord/surgery"[MeSH] OR  "Spinal Cord Diseases/surgery"[MeSH] OR "Spinal Fusion"[MeSH] OR "Laminectomy"[MeSH] OR "Diskectomy"[MeSH] OR  ("vertebroplasty"[MeSH Terms] OR "vertebroplasty"[All Fields]) OR ("kyphoplasty"[MeSH Terms] OR "kyphoplasty"[All Fields]) OR spinal  surgery[All Fields] OR spine surgery[All Fields]) AND ("Antibiotic Prophylaxis"[MeSH] OR ("Anti‐Bacterial Agents"[MeSH] OR "Anti‐Bacterial  Agents"[Pharmacological Action]) OR "Antibiotic Prophylaxis"[All Fields])) NOT ((("Spine/surgery"[MeSH] OR "Spinal Injuries/surgery"[MeSH]  OR "Spinal Diseases/surgery"[MeSH] OR "Spinal Cord/surgery"[MeSH] OR "Spinal Cord Diseases/surgery"[MeSH] OR "Spinal Fusion"[MeSH]  OR "Laminectomy"[MeSH] OR "Diskectomy"[MeSH] OR ("vertebroplasty"[MeSH Terms] OR "vertebroplasty"[All Fields]) OR  ("kyphoplasty"[MeSH Terms] OR "kyphoplasty"[All Fields]) OR spinal surgery[All Fields] OR spine surgery[All Fields]) AND ("Antibiotic  Prophylaxis"[MeSH] OR ("Anti‐Bacterial Agents"[MeSH] OR "Anti‐Bacterial Agents"[Pharmacological Action]) OR "Antibiotic Prophylaxis"[All  Fields])) NOT ("child"[MeSH Terms] OR "child"[All Fields])) AND "adult"[MeSH Terms]) AND (English[lang] AND ("1990"[PDAT] :  "3000"[PDAT]))) AND ("Infection"[MeSH] OR "Bacterial Infections"[MeSH] OR (infect[title] OR infecta[title] OR infectability[title] OR  infectable[title] OR infectans[title] OR infectant[title] OR infectants[title] OR infectation[title] OR infectcheck[title] OR infectd[title] OR  infecte[title] OR infectecd[title] OR infectech's[title] OR infected[title] OR infected/acquired[title] OR infected/affected[title] OR  infected/aids[title] OR infected/contaminated[title] OR infected/necrotic[title] OR infected/septic[title] OR infected'[title] OR  infectedith[title] OR infectednaturally[title] OR infectedness[title] OR infectedwith[title] OR infectees[title] OR infectei[title] OR infecti[title]  OR infectibility[title] OR infectible[title] OR infectied[title] OR infecties[title] OR infectieuse[title] OR infectieuses[title] OR  infectimmunology[title] OR infectin[title] OR infecting[title] OR infectins[title] OR infectio[title] OR infectio2[title] OR infectioks[title] OR  infectiologic[title] OR infectiological[title] OR infectiologist[title] OR infectiologist's[title] OR infectiologues[title] OR infectiology[title] OR  infection[title] OR infection/acquired[title] OR infection/aids[title] OR infection/antibiotic[title] OR infection/bacteremia[title] OR  infection/cerebral[title] OR infection/coinfection[title] OR infection/colonisation[title] OR infection/colonisations[title] OR 

13

infection/colonization[title] OR infection/competition[title] OR infection/compression[title] OR infection/coronary[title] OR  infection/disease[title] OR infection/drug[title] OR infection/hiv[title] OR infection/human[title] OR infection/immunity[title] OR  infection/immunization[title] OR infection/inflammation[title] OR infection/inflammations[title] OR infection/irritation[title] OR  infection/multiplicity[title] OR infection/nsaid[title] OR infection/pneumonia[title] OR infection/pneumonitis[title] OR infection/puo[title] OR  infection/reactivation[title] OR infection/reinfection[title] OR infection/replication[title] OR infection/sepsis[title] OR infection/sexually[title]  OR infection/stasis[title] OR infection/suspected[title] OR infection/systemic[title] OR infection/transmission[title] OR  infection/vaginitis[title] OR infection'[title] OR infection's[title] OR infectiona[title] OR infectional[title] OR infectiondouble[title] OR  infectionin[title] OR infectionist[title] OR infectionists[title] OR infectionof[title] OR infections[title] OR infections/a[title] OR  infections/aids[title] OR infections/hiv[title] OR infections/illness[title] OR infections/illnesses[title] OR infections/inflammation[title] OR  infections/phlebitis[title] OR infections/sexually[title] OR infections/world[title] OR infections'[title] OR infections's[title] OR infectionsa[title]  OR infectionscaused[title] OR infectionus[title] OR infectionx[title] OR infectioons[title] OR infectior[title] OR infectiosa[title] OR  infectiosity[title] OR infectiosum[title] OR infectiosus[title] OR infectious[title] OR infectious/inflammatory[title] OR  infectious/noninfectious[title] OR infectious/parasitic[title] OR infectious/toxic[title] OR infectious'[title] OR infectious'disease[title] OR  infectiousallergic[title] OR infectiousness[title] OR infectitious[title] OR infectius[title] OR infective[title] OR infective/inflammatory[title] OR  infective'[title] OR infectiveness[title] OR infectives[title] OR infectivities[title] OR infectivity[title] OR infectivityand[title] OR  infectivityof[title] OR infectivologists[title] OR infectivology[title] OR infectliga[title] OR infecto[title] OR infectoallergic[title] OR  infectobesity[title] OR infectocaryone[title] OR infectoepidemilogic[title] OR infectogenomics[title] OR infectologia[title] OR  infectologist[title] OR infectologist's[title] OR infectologists[title] OR infectology[title] OR infectome[title] OR infectomic[title] OR  infectomics[title] OR infecton[title] OR infectons[title] OR infector[title] OR infectoria[title] OR infectors[title] OR infectosome[title] OR  infectous[title] OR infectrons[title] OR infects[title] OR infectueux[title] OR infectus[title] OR infectvac[title]))) AND ("administration and  dosage"[Subheading] OR "Drug Administration Schedule"[MeSH] OR "Drug Therapy"[MeSH] OR "drug therapy"[Subheading])) AND  ("Prostheses and Implants"[MeSH] OR "Prosthesis Implantation"[MeSH] OR "instrumentation"[Subheading] OR instrumentation[title] OR  "Orthopedic Fixation Devices"[MeSH] OR ("vertebroplasty"[MeSH Terms] OR "vertebroplasty"[All Fields]) OR ("kyphoplasty"[MeSH Terms]  OR "kyphoplasty"[All Fields]))    8. What is a reasonable algorithmic approach for antibiotic selection for a given patient?  (((("Spine/surgery"[MeSH] OR "Spinal Injuries/surgery"[MeSH] OR "Spinal Diseases/surgery"[MeSH] OR "Spinal Cord/surgery"[MeSH] OR  "Spinal Cord Diseases/surgery"[MeSH] OR "Spinal Fusion"[MeSH] OR "Laminectomy"[MeSH] OR "Diskectomy"[MeSH] OR  ("vertebroplasty"[MeSH Terms] OR "vertebroplasty"[All Fields]) OR ("kyphoplasty"[MeSH Terms] OR "kyphoplasty"[All Fields]) OR spinal  surgery[All Fields] OR spine surgery[All Fields]) AND ("Antibiotic Prophylaxis"[MeSH] OR ("Anti‐Bacterial Agents"[MeSH] OR "Anti‐Bacterial  Agents"[Pharmacological Action]) OR "Antibiotic Prophylaxis"[All Fields])) NOT ("child"[MeSH Terms] OR "child"[All Fields])) OR 

14

((("Spine/surgery"[MeSH] OR "Spinal Injuries/surgery"[MeSH] OR "Spinal Diseases/surgery"[MeSH] OR "Spinal Cord/surgery"[MeSH] OR  "Spinal Cord Diseases/surgery"[MeSH] OR "Spinal Fusion"[MeSH] OR "Laminectomy"[MeSH] OR "Diskectomy"[MeSH] OR  ("vertebroplasty"[MeSH Terms] OR "vertebroplasty"[All Fields]) OR ("kyphoplasty"[MeSH Terms] OR "kyphoplasty"[All Fields]) OR spinal  surgery[All Fields] OR spine surgery[All Fields]) AND ("Antibiotic Prophylaxis"[MeSH] OR ("Anti‐Bacterial Agents"[MeSH] OR "Anti‐Bacterial  Agents"[Pharmacological Action]) OR "Antibiotic Prophylaxis"[All Fields])) NOT ((("Spine/surgery"[MeSH] OR "Spinal Injuries/surgery"[MeSH]  OR "Spinal Diseases/surgery"[MeSH] OR "Spinal Cord/surgery"[MeSH] OR "Spinal Cord Diseases/surgery"[MeSH] OR "Spinal Fusion"[MeSH]  OR "Laminectomy"[MeSH] OR "Diskectomy"[MeSH] OR ("vertebroplasty"[MeSH Terms] OR "vertebroplasty"[All Fields]) OR  ("kyphoplasty"[MeSH Terms] OR "kyphoplasty"[All Fields]) OR spinal surgery[All Fields] OR spine surgery[All Fields]) AND ("Antibiotic  Prophylaxis"[MeSH] OR ("Anti‐Bacterial Agents"[MeSH] OR "Anti‐Bacterial Agents"[Pharmacological Action]) OR "Antibiotic Prophylaxis"[All  Fields])) NOT ("child"[MeSH Terms] OR "child"[All Fields])) AND "adult"[MeSH Terms]) AND (English[lang] AND ("1990"[PDAT] :  "3000"[PDAT]))) AND (algorithm[All Fields] OR algorithm/configuration[All Fields] OR algorithm/decision[All Fields] OR algorithm/human[All  Fields] OR algorithm/methodology[All Fields] OR algorithm/model[All Fields] OR algorithm/molecular[All Fields] OR algorithm/neural[All  Fields] OR algorithm/partial[All Fields] OR algorithm/program[All Fields] OR algorithm/program/parameter[All Fields] OR algorithm/rater[All  Fields] OR algorithm/sensitivity[All Fields] OR algorithm/simulated[All Fields] OR algorithm/software[All Fields] OR algorithm/support[All  Fields] OR algorithm'[All Fields] OR algorithm''[All Fields] OR algorithm's[All Fields] OR algorithm2[All Fields] OR algorithm67[All Fields] OR  algorithma[All Fields] OR algorithmatically[All Fields] OR algorithmbased[All Fields] OR algorithme[All Fields] OR algorithmen[All Fields] OR  algorithmenbildung[All Fields] OR algorithmenvergleich[All Fields] OR algorithmes[All Fields] OR algorithmes/batiment[All Fields] OR  algorithmfs[All Fields] OR algorithmic[All Fields] OR algorithmic/complexity[All Fields] OR algorithmic/technological[All Fields] OR  algorithmica[All Fields] OR algorithmical[All Fields] OR algorithmically[All Fields] OR algorithmics[All Fields] OR algorithmique[All Fields] OR  algorithmiques[All Fields] OR algorithmis[All Fields] OR algorithmisation[All Fields] OR algorithmische[All Fields] OR algorithmizability[All  Fields] OR algorithmization[All Fields] OR algorithmize[All Fields] OR algorithmized[All Fields] OR algorithmn[All Fields] OR algorithms[All  Fields] OR algorithms/approaches[All Fields] OR algorithms/criteria[All Fields] OR algorithms/equations[All Fields] OR  algorithms/guidelines[All Fields] OR algorithms/heuristics[All Fields] OR algorithms/inhomogeneity[All Fields] OR algorithms/methods[All  Fields] OR algorithms/parameters[All Fields] OR algorithms/programs[All Fields] OR algorithms/protocols[All Fields] OR  algorithms/resources[All Fields] OR algorithms/scores[All Fields] OR algorithms/sensitivities[All Fields] OR algorithms/services[All Fields] OR  algorithms/simulated[All Fields] OR algorithms/strategy[All Fields] OR algorithms/systems[All Fields] OR algorithms'[All Fields] OR  algorithms''[All Fields] OR algorithms's[All Fields] OR algorithmsbut[All Fields] OR algorithmsfrom[All Fields] OR algorithmus[All Fields])    Redosing  9. For patients receiving antibiotic prophylaxis prior to spine surgery, what are the intraoperative redosing recommendations for the  recommended drugs (including dosages and time of administration) resulting in decreased postoperative infection rates? 

15

((((("Spine/surgery"[MeSH] OR "Spinal Injuries/surgery"[MeSH] OR "Spinal Diseases/surgery"[MeSH] OR "Spinal Cord/surgery"[MeSH] OR  "Spinal Cord Diseases/surgery"[MeSH] OR "Spinal Fusion"[MeSH] OR "Laminectomy"[MeSH] OR "Diskectomy"[MeSH] OR  ("vertebroplasty"[MeSH Terms] OR "vertebroplasty"[All Fields]) OR ("kyphoplasty"[MeSH Terms] OR "kyphoplasty"[All Fields]) OR spinal  surgery[All Fields] OR spine surgery[All Fields]) AND ("Antibiotic Prophylaxis"[MeSH] OR ("Anti‐Bacterial Agents"[MeSH] OR "Anti‐Bacterial  Agents"[Pharmacological Action]) OR "Antibiotic Prophylaxis"[All Fields])) NOT ("child"[MeSH Terms] OR "child"[All Fields])) OR  ((("Spine/surgery"[MeSH] OR "Spinal Injuries/surgery"[MeSH] OR "Spinal Diseases/surgery"[MeSH] OR "Spinal Cord/surgery"[MeSH] OR  "Spinal Cord Diseases/surgery"[MeSH] OR "Spinal Fusion"[MeSH] OR "Laminectomy"[MeSH] OR "Diskectomy"[MeSH] OR  ("vertebroplasty"[MeSH Terms] OR "vertebroplasty"[All Fields]) OR ("kyphoplasty"[MeSH Terms] OR "kyphoplasty"[All Fields]) OR spinal  surgery[All Fields] OR spine surgery[All Fields]) AND ("Antibiotic Prophylaxis"[MeSH] OR ("Anti‐Bacterial Agents"[MeSH] OR "Anti‐Bacterial  Agents"[Pharmacological Action]) OR "Antibiotic Prophylaxis"[All Fields])) NOT ((("Spine/surgery"[MeSH] OR "Spinal Injuries/surgery"[MeSH]  OR "Spinal Diseases/surgery"[MeSH] OR "Spinal Cord/surgery"[MeSH] OR "Spinal Cord Diseases/surgery"[MeSH] OR "Spinal Fusion"[MeSH]  OR "Laminectomy"[MeSH] OR "Diskectomy"[MeSH] OR ("vertebroplasty"[MeSH Terms] OR "vertebroplasty"[All Fields]) OR  ("kyphoplasty"[MeSH Terms] OR "kyphoplasty"[All Fields]) OR spinal surgery[All Fields] OR spine surgery[All Fields]) AND ("Antibiotic  Prophylaxis"[MeSH] OR ("Anti‐Bacterial Agents"[MeSH] OR "Anti‐Bacterial Agents"[Pharmacological Action]) OR "Antibiotic Prophylaxis"[All  Fields])) NOT ("child"[MeSH Terms] OR "child"[All Fields])) AND "adult"[MeSH Terms]) AND (English[lang] AND ("1990"[PDAT] :  "3000"[PDAT]))) AND ("Infection"[MeSH] OR "Postoperative Complications"[MeSH] OR "Bacterial Infections"[MeSH] OR "Intraoperative  Complications"[MeSH] OR "Intraoperative Period"[MeSH] OR "Perioperative Care"[MeSH] OR infection[title])) AND ("administration and  dosage"[Subheading] OR "Drug Administration Schedule"[MeSH] OR "Drug Therapy"[MeSH] OR "drug therapy"[Subheading] OR dose[title]  OR dosage[title] OR redosing[title] OR dosing[title]) AND ((intraoperat'iv[All Fields] OR intraoperate[All Fields] OR intraoperately[All Fields]  OR intraoperatic[All Fields] OR intraoperatieve[All Fields] OR intraoperatiewe[All Fields] OR intraoperatif[All Fields] OR intraoperating[All  Fields] OR intraoperation[All Fields] OR intraoperational[All Fields] OR intraoperationally[All Fields] OR intraoperations[All Fields] OR  intraoperatisionnogo[All Fields] OR intraoperatisionnym[All Fields] OR intraoperativ[All Fields] OR intraoperative[All Fields] OR  intraoperative/autopsy[All Fields] OR intraoperative/early[All Fields] OR intraoperative/external[All Fields] OR intraoperative/immediate[All  Fields] OR intraoperative/intraprocedural[All Fields] OR intraoperative/laparoscopic[All Fields] OR intraoperative/perioperative[All Fields] OR  intraoperative/post[All Fields] OR intraoperative/postoperative[All Fields] OR intraoperative/prolonged[All Fields] OR  intraoperative/surgical[All Fields] OR intraoperative/y[All Fields] OR intraoperative'[All Fields] OR intraoperatived[All Fields] OR  intraoperativefinding[All Fields] OR intraoperativefluoroscopy[All Fields] OR intraoperativel[All Fields] OR intraoperativelly[All Fields] OR  intraoperatively[All Fields] OR intraoperativem[All Fields] OR intraoperativen[All Fields] OR intraoperativeperformance[All Fields] OR  intraoperativer[All Fields] OR intraoperatives[All Fields] OR intraoperativev[All Fields] OR intraoperativly[All Fields] OR intraoperativna[All  Fields] OR intraoperativnata[All Fields] OR intraoperativne[All Fields] OR intraoperativni[All Fields] OR intraoperativnih[All Fields] OR  intraoperativnim[All Fields] OR intraoperativno[All Fields] OR intraoperativnog[All Fields] OR intraoperativnoj[All Fields] OR 

16

intraoperativnoto[All Fields] OR intraoperativnye[All Fields] OR intraoperatoare[All Fields] OR intraoperatoire[All Fields] OR  intraoperatoires[All Fields] OR intraoperator[All Fields] OR intraoperatora[All Fields] OR intraoperatori[All Fields] OR intraoperatoria[All  Fields] OR intraoperatorial[All Fields] OR intraoperatoriamente[All Fields] OR intraoperatorias[All Fields] OR intraoperatorie[All Fields] OR  intraoperatorii[All Fields] OR intraoperatorily[All Fields] OR intraoperatorio[All Fields] OR intraoperatorios[All Fields] OR intraoperatory[All  Fields] OR intraoperatorycholangiography[All Fields] OR intraoperatsiina[All Fields] OR intraoperatsiinoi[All Fields] OR intraoperatsiinoiu[All  Fields] OR intraoperatsion[All Fields] OR intraoperatsionnaia[All Fields] OR intraoperatsionnoe[All Fields] OR intraoperatsionnogo[All Fields]  OR intraoperatsionnoi[All Fields] OR intraoperatsionnom[All Fields] OR intraoperatsionnomu[All Fields] OR intraoperatsionnuiu[All Fields] OR  intraoperatsionnye[All Fields] OR intraoperatsionnyi[All Fields] OR intraoperatsionnykh[All Fields] OR intraoperatsionnym[All Fields] OR  intraoperatsyonnye[All Fields] OR intraoperattive[All Fields] OR intraoperatve[All Fields]) OR (perioperatie[All Fields] OR perioperatief[All  Fields] OR perioperatieve[All Fields] OR perioperatif[All Fields] OR perioperatiivinen[All Fields] OR perioperating[All Fields] OR  perioperation[All Fields] OR perioperational[All Fields] OR perioperationaly[All Fields] OR perioperatitive[All Fields] OR perioperativ[All  Fields] OR perioperativa[All Fields] OR perioperative[All Fields] OR perioperative/anesthetic[All Fields] OR perioperative/liver/critically[All  Fields] OR perioperative/neoadjuvant[All Fields] OR perioperative/operative[All Fields] OR perioperative/perianesthesia[All Fields] OR  perioperative/periprocedural[All Fields] OR perioperative/postoperative[All Fields] OR perioperative/posttraumatic[All Fields] OR  perioperative/procedural[All Fields] OR perioperativelly[All Fields] OR perioperatively[All Fields] OR perioperativem[All Fields] OR  perioperativen[All Fields] OR perioperativer[All Fields] OR perioperatives[All Fields] OR perioperativley[All Fields] OR perioperativly[All Fields]  OR perioperativna[All Fields] OR perioperativnih[All Fields] OR perioperativnim[All Fields] OR perioperativnog[All Fields] OR  perioperativnoi[All Fields] OR perioperativnom[All Fields] OR perioperativt[All Fields] OR perioperatoire[All Fields] OR perioperatoires[All  Fields] OR perioperatori[All Fields] OR perioperatoria[All Fields] OR perioperatorias[All Fields] OR perioperatorie[All Fields] OR  perioperatorii[All Fields] OR perioperatorio[All Fields] OR perioperatorios[All Fields] OR perioperatory[All Fields] OR perioperatsionnaia[All  Fields] OR perioperatsionnoe[All Fields] OR perioperatsionnogo[All Fields] OR perioperatsionnoi[All Fields] OR perioperatsionnom[All Fields]  OR perioperatsionnyi[All Fields] OR perioperatsionnykh[All Fields] OR perioperatsionnym[All Fields] OR perioperatur[All Fields] OR  perioperatve[All Fields] OR perioperatvely[All Fields] OR perioperatvie[All Fields] OR perioperatyvnogo[All Fields]))    Discontinuation  10. For patients receiving antibiotic prophylaxis prior to spine surgery, does discontinuation of prophylaxis at 24 hours result in decreased or  increased postoperative infection rates as compared to longer periods of administration?  ((((("Spine/surgery"[MeSH] OR "Spinal Injuries/surgery"[MeSH] OR "Spinal Diseases/surgery"[MeSH] OR "Spinal Cord/surgery"[MeSH] OR  "Spinal Cord Diseases/surgery"[MeSH] OR "Spinal Fusion"[MeSH] OR "Laminectomy"[MeSH] OR "Diskectomy"[MeSH] OR  ("vertebroplasty"[MeSH Terms] OR "vertebroplasty"[All Fields]) OR ("kyphoplasty"[MeSH Terms] OR "kyphoplasty"[All Fields]) OR spinal  surgery[All Fields] OR spine surgery[All Fields]) AND ("Antibiotic Prophylaxis"[MeSH] OR ("Anti‐Bacterial Agents"[MeSH] OR "Anti‐Bacterial 

17

Agents"[Pharmacological Action]) OR "Antibiotic Prophylaxis"[All Fields])) NOT ("child"[MeSH Terms] OR "child"[All Fields])) OR  ((("Spine/surgery"[MeSH] OR "Spinal Injuries/surgery"[MeSH] OR "Spinal Diseases/surgery"[MeSH] OR "Spinal Cord/surgery"[MeSH] OR  "Spinal Cord Diseases/surgery"[MeSH] OR "Spinal Fusion"[MeSH] OR "Laminectomy"[MeSH] OR "Diskectomy"[MeSH] OR  ("vertebroplasty"[MeSH Terms] OR "vertebroplasty"[All Fields]) OR ("kyphoplasty"[MeSH Terms] OR "kyphoplasty"[All Fields]) OR spinal  surgery[All Fields] OR spine surgery[All Fields]) AND ("Antibiotic Prophylaxis"[MeSH] OR ("Anti‐Bacterial Agents"[MeSH] OR "Anti‐Bacterial  Agents"[Pharmacological Action]) OR "Antibiotic Prophylaxis"[All Fields])) NOT ((("Spine/surgery"[MeSH] OR "Spinal Injuries/surgery"[MeSH]  OR "Spinal Diseases/surgery"[MeSH] OR "Spinal Cord/surgery"[MeSH] OR "Spinal Cord Diseases/surgery"[MeSH] OR "Spinal Fusion"[MeSH]  OR "Laminectomy"[MeSH] OR "Diskectomy"[MeSH] OR ("vertebroplasty"[MeSH Terms] OR "vertebroplasty"[All Fields]) OR  ("kyphoplasty"[MeSH Terms] OR "kyphoplasty"[All Fields]) OR spinal surgery[All Fields] OR spine surgery[All Fields]) AND ("Antibiotic  Prophylaxis"[MeSH] OR ("Anti‐Bacterial Agents"[MeSH] OR "Anti‐Bacterial Agents"[Pharmacological Action]) OR "Antibiotic Prophylaxis"[All  Fields])) NOT ("child"[MeSH Terms] OR "child"[All Fields])) AND "adult"[MeSH Terms]) AND (English[lang] AND ("1990"[PDAT] :  "3000"[PDAT]))) AND ("Infection"[MeSH] OR "Postoperative Complications"[MeSH] OR "Bacterial Infections"[MeSH] OR "Intraoperative  Complications"[MeSH] OR "Intraoperative Period"[MeSH] OR "Perioperative Care"[MeSH] OR infection[title])) AND ((discontin[All Fields] OR  discontinance[All Fields] OR discontination[All Fields] OR discontine[All Fields] OR discontined[All Fields] OR discontineud[All Fields] OR  discontineus[All Fields] OR discontining[All Fields] OR discontiniuty[All Fields] OR discontinous[All Fields] OR discontinously[All Fields] OR  discontinu[All Fields] OR discontinua[All Fields] OR discontinuacion[All Fields] OR discontinual[All Fields] OR discontinualis[All Fields] OR  discontinually[All Fields] OR discontinuance[All Fields] OR discontinuances[All Fields] OR discontinuante[All Fields] OR discontinuanti[All  Fields] OR discontinuate[All Fields] OR discontinuated[All Fields] OR discontinuating[All Fields] OR discontinuation[All Fields] OR  discontinuation/change[All Fields] OR discontinuation/completion[All Fields] OR discontinuation/continuation[All Fields] OR  discontinuation/delay[All Fields] OR discontinuation/dose[All Fields] OR discontinuation/interruption[All Fields] OR  discontinuation/interruption/reduction[All Fields] OR discontinuation/reduction[All Fields] OR discontinuation/reintroduction[All Fields] OR  discontinuation/retreatment[All Fields] OR discontinuation/safety[All Fields] OR discontinuation/substitution[All Fields] OR  discontinuation/switch[All Fields] OR discontinuation/switching[All Fields] OR discontinuation/tapering[All Fields] OR  discontinuation/unevaluable[All Fields] OR discontinuation/withdrawal[All Fields] OR discontinuation'[All Fields] OR discontinuations[All  Fields] OR discontinuations/bortezomib[All Fields] OR discontinuations/dose[All Fields] OR discontinuations/first[All Fields] OR  discontinue[All Fields] OR discontinue/change[All Fields] OR discontinue/reduce[All Fields] OR discontinue/renewal[All Fields] OR  discontinue/switch[All Fields] OR discontinued[All Fields] OR discontinued/avoided[All Fields] OR discontinued/switched[All Fields] OR  discontinued'[All Fields] OR discontinuence[All Fields] OR discontinueous[All Fields] OR discontinuer[All Fields] OR  discontinuer/augmenter/maintainer[All Fields] OR discontinuerlig[All Fields] OR discontinuerlige[All Fields] OR discontinuers[All Fields] OR  discontinuers/maintainers/augmenters[All Fields] OR discontinuers'[All Fields] OR discontinues[All Fields] OR discontinuidades[All Fields] OR  discontinuing[All Fields] OR discontinuining[All Fields] OR discontinuist[All Fields] OR discontinuist'[All Fields] OR discontinuita[All Fields] OR 

18

discontinuite[All Fields] OR discontinuiteit[All Fields] OR discontinuites[All Fields] OR discontinuities[All Fields] OR discontinuities/edges[All  Fields] OR discontinuities/line[All Fields] OR discontinuities/splits[All Fields] OR discontinuities'[All Fields] OR discontinuiting[All Fields] OR  discontinuity[All Fields] OR discontinuity/fatigue[All Fields] OR discontinuity/occlusion[All Fields] OR discontinuity/otosclerosis[All Fields] OR  discontinuity'[All Fields] OR discontinuo[All Fields] OR discontinuos[All Fields] OR discontinuosly[All Fields] OR discontinuosus[All Fields] OR  discontinuous[All Fields] OR discontinuous/absent[All Fields] OR discontinuous/conformational[All Fields] OR discontinuous/continuous[All  Fields] OR discontinuous/insular[All Fields] OR discontinuous/jumping[All Fields] OR discontinuous/satellite[All Fields] OR  discontinuous/sequencing[All Fields] OR discontinuous'[All Fields] OR discontinuously[All Fields] OR discontinuousness[All Fields] OR  discontinus[All Fields] OR discontinutation[All Fields] OR discontinute[All Fields] OR discontinuties[All Fields] OR discontinution[All Fields] OR  discontinuty[All Fields] OR discontinuum[All Fields] OR discontinvation[All Fields]) OR duration[All Fields] OR timing[All Fields] OR ("time  factors"[MeSH Terms] OR ("time"[All Fields] AND "factors"[All Fields]) OR "time factors"[All Fields]))    Wound Drains  11. For patients receiving antibiotic prophylaxis prior to spine surgery  and who receive placement of wound drains at wound closure, does  discontinuation of prophylaxis at 24 hours result in decreased or increased postoperative infection rates as compared to discontinuation of  antibiotics at time of drain removal?  ("Drainage"[MeSH] AND (((("Spine/surgery"[MeSH] OR "Spinal Injuries/surgery"[MeSH] OR "Spinal Diseases/surgery"[MeSH] OR "Spinal  Cord/surgery"[MeSH] OR "Spinal Cord Diseases/surgery"[MeSH] OR "Spinal Fusion"[MeSH] OR "Laminectomy"[MeSH] OR  "Diskectomy"[MeSH] OR ("vertebroplasty"[MeSH Terms] OR "vertebroplasty"[All Fields]) OR ("kyphoplasty"[MeSH Terms] OR  "kyphoplasty"[All Fields]) OR spinal surgery[All Fields] OR spine surgery[All Fields]) AND ("Antibiotic Prophylaxis"[MeSH] OR ("Anti‐Bacterial  Agents"[MeSH] OR "Anti‐Bacterial Agents"[Pharmacological Action]) OR "Antibiotic Prophylaxis"[All Fields])) NOT ("child"[MeSH Terms] OR  "child"[All Fields])) OR ((("Spine/surgery"[MeSH] OR "Spinal Injuries/surgery"[MeSH] OR "Spinal Diseases/surgery"[MeSH] OR "Spinal  Cord/surgery"[MeSH] OR "Spinal Cord Diseases/surgery"[MeSH] OR "Spinal Fusion"[MeSH] OR "Laminectomy"[MeSH] OR  "Diskectomy"[MeSH] OR ("vertebroplasty"[MeSH Terms] OR "vertebroplasty"[All Fields]) OR ("kyphoplasty"[MeSH Terms] OR  "kyphoplasty"[All Fields]) OR spinal surgery[All Fields] OR spine surgery[All Fields]) AND ("Antibiotic Prophylaxis"[MeSH] OR ("Anti‐Bacterial  Agents"[MeSH] OR "Anti‐Bacterial Agents"[Pharmacological Action]) OR "Antibiotic Prophylaxis"[All Fields])) NOT ((("Spine/surgery"[MeSH]  OR "Spinal Injuries/surgery"[MeSH] OR "Spinal Diseases/surgery"[MeSH] OR "Spinal Cord/surgery"[MeSH] OR "Spinal Cord  Diseases/surgery"[MeSH] OR "Spinal Fusion"[MeSH] OR "Laminectomy"[MeSH] OR "Diskectomy"[MeSH] OR ("vertebroplasty"[MeSH Terms]  OR "vertebroplasty"[All Fields]) OR ("kyphoplasty"[MeSH Terms] OR "kyphoplasty"[All Fields]) OR spinal surgery[All Fields] OR spine  surgery[All Fields]) AND ("Antibiotic Prophylaxis"[MeSH] OR ("Anti‐Bacterial Agents"[MeSH] OR "Anti‐Bacterial Agents"[Pharmacological  Action]) OR "Antibiotic Prophylaxis"[All Fields])) NOT ("child"[MeSH Terms] OR "child"[All Fields])) AND "adult"[MeSH Terms]) AND  (English[lang] AND ("1990"[PDAT] : "3000"[PDAT])))) AND ("Infection"[MeSH] OR "Postoperative Complications"[MeSH] OR "Bacterial 

19

Infections"[MeSH] OR "Intraoperative Complications"[MeSH] OR "Intraoperative Period"[MeSH] OR "Perioperative Care"[MeSH] OR  infection[title])    Body Habitus  12. For patients receiving antibiotic prophylaxis prior to spine surgery, should the recommended protocol differ based upon body habitus (eg,  body mass index)?  ("Body Mass Index"[MeSH] OR "Body Size"[MeSH] OR "obesity"[MeSH] OR obesity[title] OR "body mass"[All Fields] OR "body size"[All  Fields]) AND (((("Spine/surgery"[MeSH] OR "Spinal Injuries/surgery"[MeSH] OR "Spinal Diseases/surgery"[MeSH] OR "Spinal  Cord/surgery"[MeSH] OR "Spinal Cord Diseases/surgery"[MeSH] OR "Spinal Fusion"[MeSH] OR "Laminectomy"[MeSH] OR  "Diskectomy"[MeSH] OR ("vertebroplasty"[MeSH Terms] OR "vertebroplasty"[All Fields]) OR ("kyphoplasty"[MeSH Terms] OR  "kyphoplasty"[All Fields]) OR spinal surgery[All Fields] OR spine surgery[All Fields]) AND ("Antibiotic Prophylaxis"[MeSH] OR ("Anti‐Bacterial  Agents"[MeSH] OR "Anti‐Bacterial Agents"[Pharmacological Action]) OR "Antibiotic Prophylaxis"[All Fields])) NOT ("child"[MeSH Terms] OR  "child"[All Fields])) OR ((("Spine/surgery"[MeSH] OR "Spinal Injuries/surgery"[MeSH] OR "Spinal Diseases/surgery"[MeSH] OR "Spinal  Cord/surgery"[MeSH] OR "Spinal Cord Diseases/surgery"[MeSH] OR "Spinal Fusion"[MeSH] OR "Laminectomy"[MeSH] OR  "Diskectomy"[MeSH] OR ("vertebroplasty"[MeSH Terms] OR "vertebroplasty"[All Fields]) OR ("kyphoplasty"[MeSH Terms] OR  "kyphoplasty"[All Fields]) OR spinal surgery[All Fields] OR spine surgery[All Fields]) AND ("Antibiotic Prophylaxis"[MeSH] OR ("Anti‐Bacterial  Agents"[MeSH] OR "Anti‐Bacterial Agents"[Pharmacological Action]) OR "Antibiotic Prophylaxis"[All Fields])) NOT ((("Spine/surgery"[MeSH]  OR "Spinal Injuries/surgery"[MeSH] OR "Spinal Diseases/surgery"[MeSH] OR "Spinal Cord/surgery"[MeSH] OR "Spinal Cord  Diseases/surgery"[MeSH] OR "Spinal Fusion"[MeSH] OR "Laminectomy"[MeSH] OR "Diskectomy"[MeSH] OR ("vertebroplasty"[MeSH Terms]  OR "vertebroplasty"[All Fields]) OR ("kyphoplasty"[MeSH Terms] OR "kyphoplasty"[All Fields]) OR spinal surgery[All Fields] OR spine  surgery[All Fields]) AND ("Antibiotic Prophylaxis"[MeSH] OR ("Anti‐Bacterial Agents"[MeSH] OR "Anti‐Bacterial Agents"[Pharmacological  Action]) OR "Antibiotic Prophylaxis"[All Fields])) NOT ("child"[MeSH Terms] OR "child"[All Fields])) AND "adult"[MeSH Terms]) AND  (English[lang] AND ("1990"[PDAT] : "3000"[PDAT])))    Comorbidities  13. For patients receiving antibiotic prophylaxis prior to spine surgery, do comorbidities (other than obesity) such as diabetes, smoking,  nutritional depletion, immunodeficiencies and concurrent use of antithrombotic therapies alter the recommendations for antibiotic  prophylaxis?  (((("Spine/surgery"[MeSH] OR "Spinal Injuries/surgery"[MeSH] OR "Spinal Diseases/surgery"[MeSH] OR "Spinal Cord/surgery"[MeSH] OR  "Spinal Cord Diseases/surgery"[MeSH] OR "Spinal Fusion"[MeSH] OR "Laminectomy"[MeSH] OR "Diskectomy"[MeSH] OR 

20

("vertebroplasty"[MeSH Terms] OR "vertebroplasty"[All Fields]) OR ("kyphoplasty"[MeSH Terms] OR "kyphoplasty"[All Fields]) OR spinal  surgery[All Fields] OR spine surgery[All Fields]) AND ("Antibiotic Prophylaxis"[MeSH] OR ("Anti‐Bacterial Agents"[MeSH] OR "Anti‐Bacterial  Agents"[Pharmacological Action]) OR "Antibiotic Prophylaxis"[All Fields])) NOT ("child"[MeSH Terms] OR "child"[All Fields])) OR  ((("Spine/surgery"[MeSH] OR "Spinal Injuries/surgery"[MeSH] OR "Spinal Diseases/surgery"[MeSH] OR "Spinal Cord/surgery"[MeSH] OR  "Spinal Cord Diseases/surgery"[MeSH] OR "Spinal Fusion"[MeSH] OR "Laminectomy"[MeSH] OR "Diskectomy"[MeSH] OR  ("vertebroplasty"[MeSH Terms] OR "vertebroplasty"[All Fields]) OR ("kyphoplasty"[MeSH Terms] OR "kyphoplasty"[All Fields]) OR spinal  surgery[All Fields] OR spine surgery[All Fields]) AND ("Antibiotic Prophylaxis"[MeSH] OR ("Anti‐Bacterial Agents"[MeSH] OR "Anti‐Bacterial  Agents"[Pharmacological Action]) OR "Antibiotic Prophylaxis"[All Fields])) NOT ((("Spine/surgery"[MeSH] OR "Spinal Injuries/surgery"[MeSH]  OR "Spinal Diseases/surgery"[MeSH] OR "Spinal Cord/surgery"[MeSH] OR "Spinal Cord Diseases/surgery"[MeSH] OR "Spinal Fusion"[MeSH]  OR "Laminectomy"[MeSH] OR "Diskectomy"[MeSH] OR ("vertebroplasty"[MeSH Terms] OR "vertebroplasty"[All Fields]) OR  ("kyphoplasty"[MeSH Terms] OR "kyphoplasty"[All Fields]) OR spinal surgery[All Fields] OR spine surgery[All Fields]) AND ("Antibiotic  Prophylaxis"[MeSH] OR ("Anti‐Bacterial Agents"[MeSH] OR "Anti‐Bacterial Agents"[Pharmacological Action]) OR "Antibiotic Prophylaxis"[All  Fields])) NOT ("child"[MeSH Terms] OR "child"[All Fields])) AND "adult"[MeSH Terms]) AND (English[lang] AND ("1990"[PDAT] :  "3000"[PDAT]))) AND ("Comorbidity"[MeSH] OR "Diabetes Mellitus"[MeSH] OR "Smoking"[MeSH] OR "Nutrition Disorders"[MeSH] OR  "Immunologic Deficiency Syndromes"[MeSH] OR "Immunocompromised Host"[MeSH] OR (comorbidities[title] OR comorbidity[title] OR  comorbidity/cosyndromality[title] OR comorbidity/overlapping[title] OR comorbidity'[title]) OR "Thrombolytic Therapy"[Mesh] OR  (antithrombotic[title] OR antithrombotic/anticoagulant[title] OR antithrombotic/antiplatelet[title] OR antithrombotic/hemorrhagic[title] OR  antithrombotics[title]))    14. For patients with a history of MRSA infection, does prophylaxis with vancomycin reduce infections with MRSA compared to other  antimicrobial agents?  (((("Spine/surgery"[MeSH] OR "Spinal Injuries/surgery"[MeSH] OR "Spinal Diseases/surgery"[MeSH] OR "Spinal Cord/surgery"[MeSH] OR  "Spinal Cord Diseases/surgery"[MeSH] OR "Spinal Fusion"[MeSH] OR "Laminectomy"[MeSH] OR "Diskectomy"[MeSH] OR  ("vertebroplasty"[MeSH Terms] OR "vertebroplasty"[All Fields]) OR ("kyphoplasty"[MeSH Terms] OR "kyphoplasty"[All Fields]) OR spinal  surgery[All Fields] OR spine surgery[All Fields]) AND ("Antibiotic Prophylaxis"[MeSH] OR ("Anti‐Bacterial Agents"[MeSH] OR "Anti‐Bacterial  Agents"[Pharmacological Action]) OR "Antibiotic Prophylaxis"[All Fields])) NOT ("child"[MeSH Terms] OR "child"[All Fields])) OR  ((("Spine/surgery"[MeSH] OR "Spinal Injuries/surgery"[MeSH] OR "Spinal Diseases/surgery"[MeSH] OR "Spinal Cord/surgery"[MeSH] OR  "Spinal Cord Diseases/surgery"[MeSH] OR "Spinal Fusion"[MeSH] OR "Laminectomy"[MeSH] OR "Diskectomy"[MeSH] OR  ("vertebroplasty"[MeSH Terms] OR "vertebroplasty"[All Fields]) OR ("kyphoplasty"[MeSH Terms] OR "kyphoplasty"[All Fields]) OR spinal  surgery[All Fields] OR spine surgery[All Fields]) AND ("Antibiotic Prophylaxis"[MeSH] OR ("Anti‐Bacterial Agents"[MeSH] OR "Anti‐Bacterial  Agents"[Pharmacological Action]) OR "Antibiotic Prophylaxis"[All Fields])) NOT ((("Spine/surgery"[MeSH] OR "Spinal Injuries/surgery"[MeSH] 

21

OR "Spinal Diseases/surgery"[MeSH] OR "Spinal Cord/surgery"[MeSH] OR "Spinal Cord Diseases/surgery"[MeSH] OR "Spinal Fusion"[MeSH]  OR "Laminectomy"[MeSH] OR "Diskectomy"[MeSH] OR ("vertebroplasty"[MeSH Terms] OR "vertebroplasty"[All Fields]) OR  ("kyphoplasty"[MeSH Terms] OR "kyphoplasty"[All Fields]) OR spinal surgery[All Fields] OR spine surgery[All Fields]) AND ("Antibiotic  Prophylaxis"[MeSH] OR ("Anti‐Bacterial Agents"[MeSH] OR "Anti‐Bacterial Agents"[Pharmacological Action]) OR "Antibiotic Prophylaxis"[All  Fields])) NOT ("child"[MeSH Terms] OR "child"[All Fields])) AND "adult"[MeSH Terms]) AND (English[lang] AND ("1990"[PDAT] :  "3000"[PDAT]))) AND ("Methicillin‐Resistant Staphylococcus aureus"[Mesh] OR ("Methicillin Resistance"[Mesh] AND "Staphylococcus  aureus"[Mesh]) OR ("methicillin‐resistant staphylococcus aureus"[MeSH Terms] OR ("methicillin‐resistant"[All Fields] AND  "staphylococcus"[All Fields] AND "aureus"[All Fields]) OR "methicillin‐resistant staphylococcus aureus"[All Fields] OR "mrsa"[All Fields]))    Complications  15. What are the incidence and severity of complications/adverse events resulting from the use of prophylactic antibiotics?  (((("Spine/surgery"[MeSH] OR "Spinal Injuries/surgery"[MeSH] OR "Spinal Diseases/surgery"[MeSH] OR "Spinal Cord/surgery"[MeSH] OR  "Spinal Cord Diseases/surgery"[MeSH] OR "Spinal Fusion"[MeSH] OR "Laminectomy"[MeSH] OR "Diskectomy"[MeSH] OR  ("vertebroplasty"[MeSH Terms] OR "vertebroplasty"[All Fields]) OR ("kyphoplasty"[MeSH Terms] OR "kyphoplasty"[All Fields]) OR spinal  surgery[All Fields] OR spine surgery[All Fields]) AND ("Antibiotic Prophylaxis"[MeSH] OR ("Anti‐Bacterial Agents"[MeSH] OR "Anti‐Bacterial  Agents"[Pharmacological Action]) OR "Antibiotic Prophylaxis"[All Fields])) NOT ("child"[MeSH Terms] OR "child"[All Fields])) OR  ((("Spine/surgery"[MeSH] OR "Spinal Injuries/surgery"[MeSH] OR "Spinal Diseases/surgery"[MeSH] OR "Spinal Cord/surgery"[MeSH] OR  "Spinal Cord Diseases/surgery"[MeSH] OR "Spinal Fusion"[MeSH] OR "Laminectomy"[MeSH] OR "Diskectomy"[MeSH] OR  ("vertebroplasty"[MeSH Terms] OR "vertebroplasty"[All Fields]) OR ("kyphoplasty"[MeSH Terms] OR "kyphoplasty"[All Fields]) OR spinal  surgery[All Fields] OR spine surgery[All Fields]) AND ("Antibiotic Prophylaxis"[MeSH] OR ("Anti‐Bacterial Agents"[MeSH] OR "Anti‐Bacterial  Agents"[Pharmacological Action]) OR "Antibiotic Prophylaxis"[All Fields])) NOT ((("Spine/surgery"[MeSH] OR "Spinal Injuries/surgery"[MeSH]  OR "Spinal Diseases/surgery"[MeSH] OR "Spinal Cord/surgery"[MeSH] OR "Spinal Cord Diseases/surgery"[MeSH] OR "Spinal Fusion"[MeSH]  OR "Laminectomy"[MeSH] OR "Diskectomy"[MeSH] OR ("vertebroplasty"[MeSH Terms] OR "vertebroplasty"[All Fields]) OR  ("kyphoplasty"[MeSH Terms] OR "kyphoplasty"[All Fields]) OR spinal surgery[All Fields] OR spine surgery[All Fields]) AND ("Antibiotic  Prophylaxis"[MeSH] OR ("Anti‐Bacterial Agents"[MeSH] OR "Anti‐Bacterial Agents"[Pharmacological Action]) OR "Antibiotic Prophylaxis"[All  Fields])) NOT ("child"[MeSH Terms] OR "child"[All Fields])) AND "adult"[MeSH Terms]) AND (English[lang] AND ("1990"[PDAT] :  "3000"[PDAT]))) AND (("complications"[subheading] OR "adverse effects"[subheading]) OR ("Postoperative Complications"[Mesh] OR  "Intraoperative Complications"[Mesh])) AND ("epidemiology"[subheading] OR "statistics and numerical data"[subheading] OR  ("epidemiology"[Subheading] OR "epidemiology"[All Fields] OR "incidence"[All Fields] OR "incidence"[MeSH Terms]) OR rate[All Fields] OR  rates[All Fields])   

22

16. What strategies can be implemented to minimize complications/adverse events resulting from the use of prophylactic antibiotics in spine  surgery?  (((("Spine/surgery"[MeSH] OR "Spinal Injuries/surgery"[MeSH] OR "Spinal Diseases/surgery"[MeSH] OR "Spinal Cord/surgery"[MeSH] OR  "Spinal Cord Diseases/surgery"[MeSH] OR "Spinal Fusion"[MeSH] OR "Laminectomy"[MeSH] OR "Diskectomy"[MeSH] OR  ("vertebroplasty"[MeSH Terms] OR "vertebroplasty"[All Fields]) OR ("kyphoplasty"[MeSH Terms] OR "kyphoplasty"[All Fields]) OR spinal  surgery[All Fields] OR spine surgery[All Fields]) AND ("Antibiotic Prophylaxis"[MeSH] OR ("Anti‐Bacterial Agents"[MeSH] OR "Anti‐Bacterial  Agents"[Pharmacological Action]) OR "Antibiotic Prophylaxis"[All Fields])) NOT ("child"[MeSH Terms] OR "child"[All Fields])) OR  ((("Spine/surgery"[MeSH] OR "Spinal Injuries/surgery"[MeSH] OR "Spinal Diseases/surgery"[MeSH] OR "Spinal Cord/surgery"[MeSH] OR  "Spinal Cord Diseases/surgery"[MeSH] OR "Spinal Fusion"[MeSH] OR "Laminectomy"[MeSH] OR "Diskectomy"[MeSH] OR  ("vertebroplasty"[MeSH Terms] OR "vertebroplasty"[All Fields]) OR ("kyphoplasty"[MeSH Terms] OR "kyphoplasty"[All Fields]) OR spinal  surgery[All Fields] OR spine surgery[All Fields]) AND ("Antibiotic Prophylaxis"[MeSH] OR ("Anti‐Bacterial Agents"[MeSH] OR "Anti‐Bacterial  Agents"[Pharmacological Action]) OR "Antibiotic Prophylaxis"[All Fields])) NOT ((("Spine/surgery"[MeSH] OR "Spinal Injuries/surgery"[MeSH]  OR "Spinal Diseases/surgery"[MeSH] OR "Spinal Cord/surgery"[MeSH] OR "Spinal Cord Diseases/surgery"[MeSH] OR "Spinal Fusion"[MeSH]  OR "Laminectomy"[MeSH] OR "Diskectomy"[MeSH] OR ("vertebroplasty"[MeSH Terms] OR "vertebroplasty"[All Fields]) OR  ("kyphoplasty"[MeSH Terms] OR "kyphoplasty"[All Fields]) OR spinal surgery[All Fields] OR spine surgery[All Fields]) AND ("Antibiotic  Prophylaxis"[MeSH] OR ("Anti‐Bacterial Agents"[MeSH] OR "Anti‐Bacterial Agents"[Pharmacological Action]) OR "Antibiotic Prophylaxis"[All  Fields])) NOT ("child"[MeSH Terms] OR "child"[All Fields])) AND "adult"[MeSH Terms]) AND (English[lang] AND ("1990"[PDAT] :  "3000"[PDAT]))) AND (("complications"[subheading] OR "adverse effects"[subheading]) OR ("Postoperative Complications"[Mesh] OR  "Intraoperative Complications"[Mesh])) 

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II. Evidentiary Tables (Articles Reviewed in 2011/2012)  Question #1: For patients undergoing open spine surgery, does antibiotic prophylaxis result in decreased infection rates compared to patients who do not receive prophylaxis?

Article (Alpha by Author) Barker FG, 2nd. Efficacy of prophylactic antibiotic therapy in spinal surgery: a metaanalysis. Neurosurger y. Aug 2002;51(2):3 91-400; discussion 400-391.

Level of evidence Level II

Description of study

Prospective

Retrospective

Study design: meta-analysis Type of evidence Stated objective of study: To examine efficacy of antibiotic therapeutic prophylaxis in spinal neurosurgery combining orthopedic and neurosurgery trials (one spinal trial, four neurosurgical trials, one orthopedic trial) Type(s) of prophylaxis: cephaloridine (before and after surgery), vancomycin and gentamicin (one dose), oxacillin (24 hours), piperacillin (12 hours,) cefazolin (one dose) Total number of patients: 451 patients received antibiotics (controls 392) Number of patients in relevant subgroup(s): 451 Consecutively assigned? No Type(s) of surgery: lumbar surgery, with or without fusion Duration of follow-up: varied by study

Conclusion

Critique of methodology: Nonconsecutive patients Nonrandomized Nonmasked reviewers Nonmasked patients No validated outcome measures used Small sample size 6.9 mmol/L) or a postoperative serum glucose level of >200 mg/dL (>11.1 mmol/L) (odds ratio = 3.3, 95% confidence interval = 1.4, 7.5), obesity (odds ratio = 2.2, 95% confidence interval = 1.1, 4.7), and two or more surgical residents participating in the operative procedure (odds ratio = 2.2, 95% confidence interval = 1.0, 4.7). A decreased risk of surgical site infection was associated with operations involving the cervical spine (odds ratio = 0.3, 95% confidence interval = 0.1, 0.6).

95

Author conclusions (relative to question): Diabetes was associated with the highest independent risk of spinal surgical site infection, and an elevated preoperative or postoperative serum glucose level was also independently associated with an increased risk of surgical site infection. The role of hyperglycemia as a risk factor for surgical site infection in patients not previously diagnosed with diabetes should be investigated further. Administration of prophylactic antibiotics within one hour before the operation and increasing the antibiotic dosage to adjust for obesity are also important strategies to decrease the risk of surgical site infection after spinal operations. Rechtine GR, Bono PL, Cahill D, Bolesta MJ, Chrin AM. Postoperativ e wound infection after instrumentati on of thoracic and lumbar fractures. J Orthop Trauma. Nov 2001;15(8):5 66-569.

Level III

Prospective

Retrospective

Type of Study Design: case control evidence therapeutic Stated objective of study: To assess the infection rate in a trauma population undergoing spinal surgery. Type(s) of prophylaxis: All received prophylactic antibiotics. Total number of patients: 117 of 235 consecutive patients Number of patients in relevant subgroup(s):

Critique of methodology: Nonconsecutive patients Nonrandomized Nonmasked reviewers Nonmasked patients No validated outcome measures used Small sample size 35 kg/m2) had only a marginal association with surgical site infection (p = 0.075). Author conclusions (relative to question): Administration of prophylactic antibiotics within one hour before the operation and increasing the antibiotic dosage to adjust for obesity are also important strategies to decrease the risk of surgical site infection after spinal operations.



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Question #13: For patients receiving antibiotic prophylaxis prior to open spine surgery, do comorbidities (other than obesity) such as diabetes, smoking, nutritional depletion, immunodeficiencies and concurrent use of antithrombotic therapies alter the recommendations for antibiotic prophylaxis? Article (Alpha by Author) Hellbusch LC, HelzerJulin M, Doran SE, et al. Singledose vs multiple-dose antibiotic prophylaxis in instrumented lumbar fusion--a prospective study. Surg Neurol. Dec 2008;70(6):6 22-627; discussion 627.

Level of evidence Level II Type of evidence prognostic

Description of study

Prospective

Retrospective

Study Design: RCT Stated objective of study: To determine if the postoperative infection rate in instrumented lumbar spinal fusion is affected by postoperative antibiotic use. Examined multiple dosing regimens for protection against infection.

Conclusion

Critique of methodology Patients not enrolled at same point in their disease 200 mg/dL (>11.1 mmol/L) (odds ratio = 3.3, 95% confidence interval = 1.4, 7.5), obesity (odds ratio = 2.2, 95% confidence interval = 1.1, 4.7), and two or more surgical residents participating in the operative procedure (odds ratio = 2.2, 95% confidence interval = 1.0, 4.7). A decreased risk of surgical site infection was associated with operations involving the cervical spine (odds ratio = 0.3, 95% confidence interval = 0.1, 0.6).

with diabetes and other risk factors for surgical site infection.

Author conclusions (relative to question): Diabetes was associated with the highest independent risk of spinal surgical site infection, and an elevated preoperative or postoperative serum glucose level was also independently associated with an increased risk of surgical site infection. The role of hyperglycemia as a risk factor for surgical site infection in patients not previously diagnosed with diabetes should be investigated further. Administration of prophylactic antibiotics within one hour before the operation and increasing the antibiotic dosage to adjust for obesity are also important strategies to decrease the risk of surgical site infection after spinal operations.

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Rohde V, Meyer B, Schaller C, Hassler WE. Spondylodisc itis after lumbar discectomy. Incidence and a proposal for prophylaxis. Spine (Phila Pa 1976). Mar 1 1998;23(5):6 15-620.

Level III

Prospective

Retrospective

Study design: comparative Type of evidence Stated objective of study: To report the incidence of postoperative therapeutic spondylodiscitis in cases in which no antibiotic prophylaxis was used, and to define the value of a collagenous sponge containing gentamicin in preventing disc space infections. Type(s) of prophylaxis: collagenous sponge containing gentamicin placed in the cleared disc space Total number of patients: 1642 Number of patients in relevant subgroup(s): No topical or systemic antibiotics were administered in the first 508 patients. A 4 cm × 4 cm collagenous sponge containing 8 mg of gentamicin was placed in the cleared disc space in the subsequent 1134 patients. Consecutively assigned? Yes Type(s) of surgery: 1584 primary lumbar disc herniations (twolevel discectomy in 39 cases, three-level discectomy in one case) and 169 operations for recurrent herniations were performed in 1642 consecutive patients Duration of follow-up: 60 days

Critique of methodology: Nonconsecutive patients Nonrandomized Nonmasked reviewers Nonmasked patients No validated outcome measures used Small sample size 4hrs and procedures >1500cc. No postop prophylaxis was administered. Infection was defined by purulent discharge, or serous discharge with culture, or deep/superficial abscess, or spondylodiscitis. Nine cases of infection were reported: staph = 4, coag – staph=2, kleibsiella=1 and pseudomonas=1. Two cases cultured negative. This is a retrospective study of one year’s patients (40) who had either ‘simple discectomy’ or instrumented procedures. Cefuroxime 1.5 g was given preop and q4h for 48h. Gentamycin 80 mg iv preop and q6h intraop and q8h postop for 48h. No infections occurred in the 40 patients. This paper includes a good discussion of the basic science behind the use of cefurozime and gentamicin as readily disc-eluting antibiotics v. cephazolin as a less disceluting antibiotic.

This study is Level IV evidence.

As a retrospective study, chart review for evidence of post op infection (and finding none) in an extremely small cohort (40), no conclusions regarding efficacy of specific regimen can be drawn. This is an extension of a basic science study looking at the penetration of cephazolin, gentamicin and cefuroxime into disc tissue. The only thing it shows for our needs is that redosing in a small cohort over one year led to no infections. As such it is Level IV evidence.

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Antibiotic Prophylaxis - Discontinuation Question 8: For patients receiving antibiotic prophylaxis prior to spine surgery, does discontinuation of prophylaxis at 24 hours result in decreased or increased postoperative infection rates as compared to longer periods of administration? -Evidentiary Table-

A comprehensive review of the literature did not yield evidence to address the question related to the effect of discontinuation of prophylaxis at 24 hours compared with longer periods of administration on postoperative infection rates.

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Antibiotic Prophylaxis - Wound Drains Question 9: For patients receiving antibiotic prophylaxis prior to spine surgery and who receive placement of wound drains at wound closure, does discontinuation of prophylaxis at 24 hours result in decreased or increased postoperative infection rates as compared to discontinuation of antibiotics at time of drain removal? -Evidentiary TableA comprehensive review of the literature did not yield evidence to address the question related to the effect on postoperative infection rates of the duration of prophylaxis in the presence of a wound drain. The study below suggests that drains do not influence infection rates in patients with single level decompressive procedures.

Article Level (Alpha by (I-V) Author) Payne DH, II Fischgrund JS, Herkowitz HN, Barry RL, Kurz LT, Montgomery DM. Efficacy of closed wound suction drainage after singlelevel lumbar

Description of study (Including analysis of methodological strengths/weaknesses) This is a randomized controlled trial of drain use in 205 patients undergoing a single level laminectomy without fusion. The patients were randomized to drain vs. no drain. There was no difference between the groups in terms of infection rates.

Conclusion

This study appears on the surface as Level I evidence. However, it was downgraded to Level II because it was substantially underpowered. It provides Level II evidence that drains have no effect on infection rates. For a single level nonfusion spine procedure a drain does not decrease nor increase the infection rate.

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laminectomy. J Spinal Disord. 1996;9(5):40 1-403.

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Antibiotic Prophylaxis - Body Habitus Question 10: For patients receiving antibiotic prophylaxis prior to spine surgery, should the recommended protocol differ based upon body habitus (eg, body mass index)? -Evidentiary Table-

Article Level (Alpha by (I-V) Author) Olsen MA, III Mayfield J, Lauryssen C, et al. Risk factors for surgical site infection in spinal surgery. J Neurosurg. 2003;98(2 Suppl):149155. Wimmer C, IV Gluch H, Franzreb M, Ogon M. Predisposing factors for

Description of study (Including analysis of methodological strengths/weaknesses) In this retrospective case-control study, 41 patients with an infection after spinal surgery were compared to 178 without infection in order to determine potential risk factors. As identified by investigators ,postoperative urinary incontinence, posterior approach, surgery for tumor, and morbid obesity (BMI >35) were independent risk factors for postoperative wound infection. All patients received one or more doses of prophylactic cefazolin with or without an aminoglycoside or vancomycin with an aminoglycoside. Fusion or the use of instrumentation was not found to be a risk for infection. In this retrospective study of 850 spinal procedures, all patients received 2 gm of cefazolin IV perioperatively and a single additional injection if the surgery lasted more than three hours. In an analysis of the 22 patients who developed an infection, six

Conclusion

In critique of this study, it was a retrospective review of a limited number of patients. In addition, the specific antibiotic regimens given to obese and non-obese patients was not analyzed. However, these data offer Level III evidence that morbid obesity defined as a BMI more than 35 is an independent risk factor for infection despite the use of a standardized antibiotic prophylaxis regimen. This study does not offer any evidence concerning specific antibiotic prophylaxis for obese patients.

In critique of this study, there was no analysis of adjustments made to the antibiotic regimen in relation to the patients’ BMI. Although other risk factors were considered more important, obesity was found to be an independent risk factor for postoperative infection in this retrospective review despite the use of prophylactic antibiotics. This study offers Level IV 176



infection in spine surgery: a survey of 850 spinal procedures. J Spinal Disord. 1998;11(2):1 24-128.

were obese. Analyzed as a subgroup, obesity was found to be a risk factor with a p-value

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