TOPICAL IRRIGATION WITH POLYMYXIN AND BACITRACIN FOR SPINAL SURGERY

BACKGROUND The purpose of the present study was to evaluate constant i rrigation with saline containing 50,000 units each of polymyxin and ba citracin in a regimen of antimicrobial prophylaxis for clean spinal su rgery at two community hospitals with a zero infection rate. METHODS T he focus was on the bactericidal effects of prophylactic topical antib iotics by assessing random contamination in neurosurgical wounds from: 1) the flora of the integument and nares of the operating team, 2) th e surgical apparel, 3) the patient's skin, 4) air-borne organisms in t he operating theater, and 5) the surgeon's gloves. RESULTS Based on in dividual biotyping of bacteria and antimicrobial sensitivity testing, no consistent source or pattern could be uncovered for the organisms r ecovered from the operative site. Relying on longitudinal data, the in cidence of intraoperative bacterial growth with continuous saline lava ge was reduced from 64 to 4% when the combination of topical polymyxin and bacitracin was added. CONCLUSIONS Although the virtual eliminatio n of bacterial growth in the surgical site was accomplished, the effic acy of topical antibiotics in the prevention of wound infection remain s unproven. (C) 1998 by Elsevier Science Inc.