Surgical irrigation with pooled human immunoglobulin G to reduce post-operative spinal implant infection

A multiple-site, nonlethal rabbit surgical model of spinal implant infectio n was used to assess the efficacy of a spinal wound lavage to reduce post-o perative infection from methicillin-resistant Staphylococcus aureus (MRSA). Multiple aqueous lavages of isotonic saline were compared to the same proc edure using 1wt% pooled human immunoglobulin G (IgG) applied directly to th e surgical implant sites. Visually observed clinically relevant signs of in fection (e.g., swelling, erythema, pus) were supported by bacterial enumera tion from multiple biopsied tissue and bone sites post-mortem at 7 and 28 d ays post-challenge. Clinical signs of infection were significantly reduced in IgG-lavaged infected spinal sites. Bacterial enumeration also exhibited statistically significant reductions in soft tissues, bone and on K-wire sp inal implants using IgG lavage compared with saline. Complete healing of al l surgical wounds was seen after 28 days, although isolated fibrosed absces ses were observed in autopsied sites treated with both IgG and saline lavag es. Local use of IgG wound lavage is proposed as supplementary infection pr ophylaxis against antibiotic resistant implant-centered or surgical wound i nfection.