{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:31:24Z","timestamp":1787027484637,"version":"build-2736575974"},"reference-count":47,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T00:00:00Z","timestamp":1772755200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100014188","name":"National Research Foundation of Korea","doi-asserted-by":"publisher","award":["RS-2025-24683650"],"award-info":[{"award-number":["RS-2025-24683650"]}],"id":[{"id":"10.13039\/501100014188","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Background\/Objectives: Surgical site infection (SSI) remains a significant complication following spine surgery, yet the optimal duration of prophylactic antibiotic administration remains debated. We investigated the association between prophylactic antibiotic duration and SSI rates following spine surgery using a nationwide claims database. Methods: This retrospective cohort study analyzed data from the Health Insurance Review and Assessment Service quality assessment database across four assessment waves (2014\u20132020, sixth to ninth). Adult patients (aged \u226519 years) undergoing elective spine surgery (decompression, instrumented fusion, vertebroplasty, or kyphoplasty) were categorized into two groups based on prophylactic antibiotic duration: &lt;24 h or \u226524 h. Surgery type was the primary surgical categorization, while surgery site (cervical, thoracic, lumbar) was assessed separately in supplemental analyses. Primary outcomes included SSI, non-surgical-site infections, and total postoperative infections within 3 months. Multivariable logistic regression was performed to identify independent predictors of infection. Results: Of 82,840 patients included, 19,988 (24.1%) discontinued prophylactic antibiotics within 24 h and 62,852 (75.9%) continued antibiotics for \u226524 h. The &lt;24 h group demonstrated significantly lower SSI rates compared to the \u226524 h group (0.16% vs. 1.47%, p &lt; 0.05). After adjustment for confounders, prolonged antibiotic prophylaxis (\u226524 h) was associated with increased odds of SSI (adjusted odds ratio [aOR] = 10.73, 95% CI = 7.30\u201315.79), non-surgical-site infections (aOR = 16.06, 95% CI = 13.11\u201319.67), and total postoperative infections (aOR = 17.82, 95% CI = 14.83\u201321.42). Conclusions: In this nationwide cohort, early discontinuation of prophylactic antibiotics within 24 h was not associated with increased SSI risk. Prolonged antibiotic prophylaxis beyond 24 h was associated with higher SSI rates, although confounding by indication likely contributed to this finding. These results are consistent with current guideline recommendations for limiting prophylactic antibiotic duration to 24 h or less in routine spine surgery, while recognizing that individualized approaches may be warranted in some high-risk patients.<\/jats:p>","DOI":"10.3390\/antibiotics15030272","type":"journal-article","created":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T09:22:14Z","timestamp":1772788934000},"page":"272","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Early Discontinuation of Prophylactic Antibiotics Is Not Associated with Increased Surgical Site Infection Risk in Spine Surgery: A Nationwide Cohort Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0712-9152","authenticated-orcid":false,"given":"Sangjun","family":"Park","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Eunpyeong St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea"},{"name":"Department of Orthopedic Surgery, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun-Seok","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Eunpyeong St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1237-4600","authenticated-orcid":false,"given":"Young-Hoon","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2758-0012","authenticated-orcid":false,"given":"Sang-Il","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1680-7778","authenticated-orcid":false,"given":"Youngjin","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Public Health, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9730-9845","authenticated-orcid":false,"given":"Sukil","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Public Health, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0084-8867","authenticated-orcid":false,"given":"Hyung-Youl","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Eunpyeong St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1097\/BRS.0000000000003218","article-title":"Incidence of Surgical Site Infection after Spine Surgery: A Systematic Review and Meta-Analysis","volume":"45","author":"Zhou","year":"2020","journal-title":"Spine"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1097\/BRS.0b013e3181eadd41","article-title":"Rates of Infection After Spine Surgery Based on 108,419 Procedures: A Report from the Scoliosis Research Society Morbidity and Mortality Committee","volume":"36","author":"Smith","year":"2011","journal-title":"Spine"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"E269","DOI":"10.1097\/BRS.0000000000004713","article-title":"Incidence and Recurrence of Deep Spine Surgical Site Infections: A Systematic Review and Meta-Analysis","volume":"48","author":"Sarraj","year":"2023","journal-title":"Spine"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1097\/BRS.0000000000002277","article-title":"The Effect of Postoperative Spinal Infections on Patient Mortality","volume":"43","author":"Casper","year":"2018","journal-title":"Spine"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1017\/ice.2022.32","article-title":"Risk and Economic Burden of Surgical Site Infection Following Spinal Fusion in Adults","volume":"44","author":"Edmiston","year":"2023","journal-title":"Infect. 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