From the Guidelines
Bacitracin ointment is not the preferred choice for topical treatment of wounds around a spinal (SP) catheter, and its use should be guided by the presence of specific infections and healthcare provider recommendations. The most recent and highest quality study 1 suggests that topical antiseptic/antibiotic ointments can reduce the risk of catheter-related bloodstream infections (CRBSI), but it specifically mentions mupirocin, povidone-iodine, and Polysporin triple-antibiotic ointment as effective options. While bacitracin is mentioned in older guidelines 1 as part of a combination ointment (bacitracin/gramicidin/polymyxin B) for use at the hemodialysis catheter exit site, its effectiveness and safety profile for spinal catheter sites are not well-established in recent literature.
Key considerations for the care of spinal catheter sites include:
- Gentle cleansing with mild soap and water once daily or when soiled
- Thorough drying of the area after cleaning
- Avoidance of routine use of topical antimicrobials like bacitracin, which may disrupt normal skin flora and potentially lead to antibiotic resistance or skin sensitization
- Reservation of topical antimicrobials for cases with clear signs of infection, under healthcare provider guidance
- Monitoring for signs of infection such as redness, unusual drainage, increasing pain, swelling, or warmth, which may require medical evaluation
Institutional protocols and individual patient needs may vary, and some providers may recommend applying a clean, dry gauze dressing around the catheter if there is drainage. However, the primary approach should focus on keeping the area clean and dry to prevent infection while maintaining skin integrity, as supported by guidelines 1.
From the Research
Effectiveness of Bacitracin for Topical Treatment of Wounds
- The effectiveness of bacitracin as a topical antibiotic for wound treatment is supported by some studies, although the evidence is not always consistent 2, 3.
- A study published in 2016 found that topical antibiotics, including bacitracin, probably reduce the risk of surgical site infections (SSIs) in people with surgical wounds healing by primary intention compared with no topical antibiotic or topical antiseptics 2.
- Another study from 1991 suggested that triple antibiotic solution (neomycin, polymyxin, and bacitracin) provides broad-spectrum antimicrobial activity and can be effective in preventing infections in orthopedic surgical cases 3.
Safety and Potential Risks
- However, there are also concerns about the potential risks of using bacitracin, including the increasing incidence of allergy to this agent 4.
- A study published in 2017 noted that local hypersensitivity reactions, particularly to older agents like bacitracin, are a challenge in the use of topical antimicrobials 5.
- Another study from 2011 found that antibiotic-based ointments, including those containing bacitracin, may not be necessary for wound healing and can cause allergic contact dermatitis 6.
Specific Use for Spinal (SP) Catheter Wounds
- There is limited direct evidence on the effectiveness of bacitracin for topical treatment of wounds around a spinal (SP) catheter.
- However, the general principles of wound care and infection prevention may still apply, and topical antibiotics like bacitracin may be considered as part of a broader wound care strategy 2, 3.