Risk-Stratified Antibiotic Prophylaxis

A 7-day extended oral antibiotic course in high-risk individuals significantly reduced surgical infection rates over 1 year. A uniform prophylaxis policy may be unsuitable for elective spinal surgery given the diversity of procedures and patient risk profiles. North American Spine Society guidelines support individualised prophylaxis for high-risk patients, including intrawound vancomycin and gram-negative coverage. Future research should incorporate microbial culture data and develop frameworks for tailoring prophylactic antibiotic regimens to specific patient and surgical profiles. NASS high-risk criteria include obesity, diabetes, neurologic deficits, incontinence, trauma, and prolonged multilevel instrumented surgery. The study recommends refining QA guidelines to account for surgical complexity and patient risk, with broader or longer prophylaxis reserved for complex or high-risk cases.