Antibiotics for Spinal Cord Stimulation Trials and Implants: A Survey Analysis of Practice Patterns

Syena Sarrafpour; Jamal Hasoon; Ivan Urits; Omar Viswanath; Kamran Mahmoudi; Thomas T Simopoulos; Jatinder Gill; Lynn Kohan

doi:10.5812/aapm.120611

Antibiotics for Spinal Cord Stimulation Trials and Implants: A Survey Analysis of Practice Patterns

Anesth Pain Med. 2021 Oct 30;11(5):e120611. doi: 10.5812/aapm.120611. eCollection 2021 Oct.

Authors

Syena Sarrafpour¹, Jamal Hasoon¹, Ivan Urits^{1

2}, Omar Viswanath^{2

3

4}, Kamran Mahmoudi⁵, Thomas T Simopoulos¹, Jatinder Gill¹, Lynn Kohan⁶

Affiliations

¹ Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA.
² Louisiana State University Health Sciences Center, Department of Anesthesia and Pain Management, Shreveport, LA, USA.
³ Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ, USA.
⁴ University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ, USA.
⁵ Pain Research Center, Department of Anesthesiology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
⁶ University of Virginia Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Charlottesville, VA, USA.

Abstract

Background: Spinal cord stimulation (SCS) is an established treatment modality for neuropathic pain. Published guidelines exist to aid physicians in proper antibiotic use during and after spinal cord stimulation trials and implants. In this brief review, we present and analyze the current antibiotic practice patterns of clinicians.

Methods: The study protocol was reviewed and granted an exemption by an Institutional Review Board. The survey queried practice parameters in regards to spinal cord stimulation therapy. The American Society of Regional Anesthesia and Pain Medicine (ASRA) and Society of Interventional Spine (SIS) distributed the survey to their active members by emails with a web link to the survey.

Results: Our results indicate that 82% and 69% of physicians do not utilize nasal swabs for methicillin-sensitive Staphylococcus aureus (MSSA) or methicillin-resistant Staphylococcus aureus (MRSA), respectively, prior to SCS trial and implantation. During trials, 47% providers administer a single dose of antibiotics, 35% administer antibiotics for the duration of the trial, and 17% do not administer antibiotics. During implantation, 44% of physicians administer a single dose during the procedure, 11% administer antibiotics up to 24 hours, 24% administer antibiotics between 3-5 days, 14% administer antibiotics for more than 5 days, and 4% do not administer antibiotics.

Conclusions: Our study suggests a portion of pain physicians do not adhere to the Neuromodulation Appropriateness Consensus Committee (NACC) guidelines in regards to antibiotic administration for SCS trial and implantation. Further analysis and surveys would allow insight into common practices. More information and education would be beneficial to optimize peri-procedure antibiotic use to reduce infection risk and decrease antimicrobial resistance.

Keywords: Antibiotics; Bacteria; Implantable Pulse Generator; Morbidity; Nasal Swab; Neuromodulation; Spinal Cord Stimulation; Surgical Site Infections.