Intrawound Application Of Vancomycin Powder Research Articles

Intrawound Vancomycin Powder Application for Preventing Surgical Site Infection Following Cranioplasty.

Surgical site infection is the most detrimental complication following cranioplasty. In other surgical fields, intrawound vancomycin powder application has been introduced to prevent surgical site infection and is widely used based on results in multiple studies. This study evaluated the effect of intrawound vancomycin powder in cranioplasty compared with the conventional method without topical antibiotics. This retrospective study included 580 patients with skull defects who underwent cranioplasty between August 1, 1998 and December 31, 2021. The conventional method was used in 475 (81.9%; conventional group) and vancomycin powder (1g) was applied on the dura mater and bone flap in 105 (18.1%; vancomycin powder group) patients. Surgical site infection was defined as infection of the incision, organ, or space that occurred after cranioplasty. Surgical site infection within one-year surveillance period was compared between the conventional and vancomycin powder groups with logistic regression analysis. Penalized likelihood estimation method was used in logistic regression to deal with zero events. All local and systemic adverse events associated with topical vancomycin application were also evaluated. Surgical site infection occurred in 31 (5.3%) patients and all were observed in the conventional group. The median time between cranioplasty and detection of surgical site infection was 13 days (range, 4 - 333). Staphylococci were the most common organisms and identified in 25 (80.6%) of 31 cases with surgical site infections. The surgical site infection rate in the vancomycin powder group (0/105 [0%]) was significantly lower than that in the conventional group (31/475 [6.5%]; crude odds ratio 0.067 [95% confidence interval 0.006 - 0.762], adjusted odds ratio 0.068 [95% confidence interval 0.006 - 0.731]; p=0.026). No adverse events associated with intrawound vancomycin powder were observed during the follow-up. Intrawound vancomycin powder effectively prevented surgical site infections following cranioplasty without local or systemic adverse events. Our results suggest that intrawound vancomycin powder is an effective and safe strategy for patients undergoing cranioplasty.

Intrawound application of vancomycin reduces the proportion of fracture-related infections in high-risk tibial plateau fractures

IntroductionDespite the improvements in surgical techniques and the use of prophylactic intravenous antibiotics, the fracture-related infection (FRI) incidence after high-risk tibial plateau fractures remains high. This study aimed to evaluate the clinical effect of the intrawound application of vancomycin on the FRI after high-risk tibial plateau fracture surgery. MethodsA total of 243 patients who underwent high-risk tibial plateau fracture surgery from May 2013 to June 2021 were retrospectively reviewed. Of these, 233 cases were enrolled. Considering the preoperative patient condition, surgeons applied vancomycin powder directly into the surgical site before wound closure in 105 cases (intrawound application of vancomycin powder with preoperative intravenous cephalosporin). The remaining 128 cases served as the control group (preoperative intravenous cephalosporin alone). Clinical data and surgical details were recorded. The Cox proportional hazards regression analysis was used to assess risk factors for FRI. The Kaplan-Meier method and the log rank test illustrated the infection status of patients based on the application of intrawound vancomycin. The primary outcome was an FRI within one year. Secondary outcomes included bacterial culture and vancomycin-related complications. ResultsOur study demonstrated a significant difference in the incidence of FRI between the vancomycin group and the control group (3.8% versus 10.9%; p=0.041). Multivariable Cox regression showed the intrawound application of vancomycin powder decreased the rate of FRI. There were no complications related to intrawound vancomycin observed during follow-up. The presence of Gram-positive FRI was higher in the control group compared with the vancomycin group. ConclusionsIntrawound application of vancomycin was associated with a significant lower rate of FRI after high-risk tibial plateau fracture surgery compared to the control group.

The Effect of Local Administration of Vancomycin Suspended in Fibrin Glue for Prevention of Surgical Site Infection After Spinal Instrumentation: Comparison by Probability of Treatment Weighting Model.

A retrospective cohort study. To compare the surgical site infection (SSI) rate in patients undergoing spinal instrumentation surgery who received vancomycin suspended in fibrin glue at the surgical site and those who did not. The intrawound application of vancomycin powder for preventing SSI after spinal surgery remains controversial. Vancomycin suspended in fibrin glue is another option for local administration that may be effective. The present study assessed whether vancomycin suspended in fibrin glue could prevent SSI after spinal instrumentation surgery. We enrolled patients who underwent posterior spinal instrumentation surgery with or without fusion for degenerative conditions, spinal trauma, or tumor. A multiple logistic regression model with inverse probability of treatment weighting based on propensity score was used to assess the efficacy of vancomycin suspended in fibrin glue and to account for confounding. A secondary multivariate logistic regression analysis was performed to identify the risk factors associated with SSI. Of the 264 patients enrolled in this study, 134 underwent application of vancomycin suspended in fibrin glue at the surgical site and 130 did not. The incidence of SSI was lower in patients who were treated with vancomycin suspended in fibrin glue (2.2% vs. 8.5%) even after inverse probability of treatment weighting adjustment (adjusted odds ratio: 0.25; 95% CI, 0.0768-0.91; P =0.03). Multivariate logistic regression analysis showed that the treatment with vancomycin suspended in fibrin glue was significantly associated with a lower odds of SSI (odds ratio: 0.2; 95% CI, 0.05-0.85; P =0.03). The administration of vancomycin suspended in fibrin glue was significantly associated with a lower likelihood of SSI in patients undergoing spinal instrumentation surgery.

Intrawound Low-dose Vancomycin (250 mg) Powder has Lower Risk of Wound Dehiscence than Higher Doses in Spine Surgeries

Introduction: Surgical site infection post spinal surgery is a known complication which can be serious and may require aggressive intervention. Intrawound vancomycin powder application is an evolving method to prevent such complication. Although it has very low systemic complications, wound dehiscence with negative culture is reported in the literature. The aim of this study was to find the risk of wound dehiscence with low-dose intrawound vancomycin in comparison to 1 gr and its effectiveness in prevention of surgical site infection.
 Methodology: A chart review of all patients who underwent posterior thoracic, lumbar or sacral spine surgeries from December 2009 to September 2016 in a single center was done. Patients were categorized into three groups. First, patients who did not receive any intrawound vancomycin; second, patients who received high-dose vancomycin (1 gr); and third, patients who received low-dose vancomycin (250 mg). Additionally, patients’ demographic information, clinical data, and surgical variables were collected. Primary outcome was the presence of wound dehiscence or surgical site infection.
 Result: In total, 391 patients were included in this study, of which 56 (14.3%) received high-dose intrawound vancomycin, 126 (32.2%) received low dose, and 209 (53.5%) did not receive any. The overall incidence of wound dehiscence was 6.14% (24 out of 391 patients). Wound dehiscence was statistically and significantly higher (p = 0.039) in the high-dose vancomycin group in comparison to the patients who received low dose. The overall incidence of postoperative infection was 2.05% (eight patients). There was no statistically significant difference between the groups.
 Conclusion: The use of intrawound low-dose vancomycin (250 mg) has less wound dehiscence in comparison with other higher standard doses. Further trials are needed to evaluate the effectiveness of this dose in preventing postoperative infections.

Intrawound vancomycin application after spinal surgery: a propensity score-matched cohort analysis.

Surgical site infection (SSI) following spine surgery is associated with increased morbidity and healthcare costs. In an effort to reduce SSI rates, the application of intrawound vancomycin powder has gained popularity. However, there is limited high-quality evidence to support the safety and efficacy of this practice. The authors sought to determine if intrawound application of vancomycin powder improves 90-day overall SSI rates. The authors performed a retrospective, vancomycin exposure-matched cohort study at a single tertiary care hospital over 21 months. They included all patients undergoing elective spinal surgery and stratified the patients into two groups: those who received intrawound vancomycin powder application and those who received no application of vancomycin powder. The primary outcome of interest was the 90-day overall SSI rate. Secondary outcomes included rates of superficial SSI, deep SSI, wound disruption, and a post hoc analysis of the microbiology and minimum inhibitory concentrations. Baseline patient demographics, clinical presentation, comorbidities, perioperative factors, and 90-day postoperative outcomes were manually abstracted from patient charts. To mitigate bias, we performed 1:1 matching after calculating propensity scores and identified 1 patient from the no-vancomycin cohort for each patient in the vancomycin cohort. A total of 997 patients met our inclusion criteria (473 patients receiving vancomycin and 524 patients not receiving vancomycin). Propensity score matching produced 221 matched pairs. Risk-adjusted analysis demonstrated similar overall SSI rates between the groups (OR 1.9, p = 0.329). On unadjusted analysis, the overall 90-day SSI rate was greater in the vancomycin group (n = 10 [4.5%]) than in the no-vancomycin group (n = 5 [2.3%]) (p < 0.001), as were the superficial SSI rate (7 [3.2%] vs 4 [1.8%], p < 0.001), deep SSI rate (3 [1.4%] vs 1 [0.5%], p < 0.001), and wound disruption rate (5 [2.3%] vs 1 [0.5%], p < 0.001). No cultured isolate demonstrated vancomycin resistance. The authors observed no difference in SSI rates after the intrawound application of vancomycin powder during spine surgery. Vancomycin use did not contribute to antimicrobial resistance; however, it may select out gram-negative bacteria and increase rates of wound disruption.

Comparison between 1 g and 2 g of Intrawound Vancomycin Powder Application for Prophylaxis in Posterior Instrumented Thoracic or Lumbosacral Spine Surgery: A Preliminary Report.

Background:Surgical site infection (SSI) after instrumented spinal surgery is one of the most serious complications in spite of the routine use of prophylactic intravenous (IV) antibiotics. Many studies have suggested that intrawound vancomycin powder, applied during the intraoperative period, may decrease the incidence of SSI after surgery. However, the appropriate dose of vancomycin has not yet been reported.Purpose:The purpose of the study is to compare between the use of 1 g and 2 g intrawound vancomycin powder and to find out which of these two groups can reduce the rate of deep wound infection in posterior instrumented thoracic or lumbosacral spine surgery.Materials and Methods:The preliminary study was conducted from July 2013 to July 2015 at Lerdsin Hospital. A total of 400 patients were enrolled in the study, and their individual demographics were recorded. All patients underwent posterior instrumented thoracic or lumbosacral spine surgery. Of these, 131 patients received IV cefazolin and 2 g of vancomycin powder intrawound application, 134 patients received 1 g of intrawound vancomycin powder in addition to IV cefazolin, and 135 patients were given only IV cefazolin and were assigned as the control group.Results:One hundred and thirty-one patients were treated with posterior instrumented thoracic or lumbosacral fusions using IV cefazolin and adjuvant 2 g of intrawound vancomycin powder. Five patients in this group developed deep infections (3.8%). One hundred and thirty-four patients were treated with posterior instrumented thoracic or lumbosacral fusions using IV cefazolin and adjuvant 1 g of intrawound vancomycin powder. Of these, four patients developed deep infections (2.98%). One hundred and thirty-five patients in the control group were treated with posterior instrumented thoracic or lumbosacral using only IV cefazolin as prophylaxis. Of these, four patients developed deep infections (2.96%). Coagulase-negative staphylococcus was the most common isolated organism. There were no adverse clinical outcomes or wound complications due to local application of vancomycin powder.Conclusion:The preliminary result could not state the relation of intrawound vancomycin powder to the deep infection; further study with adequate sample size is required.

Topical instillation of vancomycin lowers the rate of CSF shunt infections in children.

Shunt surgery in pediatric patients still bears a significant risk of infection, in addition to mechanical complications of the shunt system. Antibiotic-impregnated systems and perioperative antibiotics have been extensively studied for their potential to reduce shunt infections. We examined the effectiveness of intrawound application of vancomycin powder during shunt surgery. Patient records of 78 primary shunt implantations at a mean age of 40months were reviewed. In total, 52 patients (mean age 50months) had been treated according to standard surgical and perioperative procedures (Std), whereas 26 patients (mean age 20months) additionally had received topical application of vancomycin powder before wound closure (Vmc). Overall infection rate was 3.8%, in Std patients 5.8%, and in Vmc patients 0%. The rates of CSF fistula and revision surgery were similar in both groups (5.8% vs 8% and 23.1% vs. 30%, respectively). To the best of our knowledge, this is the first report on topical vancomycin instillation, indicating its efficacy for the prevention of shunt infection in pediatric patients. Further studies with a higher number of patients are needed to verify this finding.

Effect of intrawound vancomycin application in spinal surgery on the incidence of surgical site infection: a meta-analysis.

BackgroundDespite great advances in aseptic surgical techniques, surgical site infection (SSI) is still one of the main complications after spine surgery. SSI can bring tremendous physical, psychological, and economic challenges to patients. Intrawound vancomycin application is a much disputed method for the prevention of SSI after spine surgery.ObjectiveThe aim of this study is to review the current literature for studies on the intra-wound application of vancomycin powder and to analyze its effectiveness in the prevention of postoperative SSI.MethodsPubMed, Medline, Elsevier, and CNKI were searched for the key words “vancomycin”, “local/intraoperative/topical/intra-wound”, “spine/spinal/lumbar/cervical/thoracolumbar surgery”, “infection”, and “SSI” in published studies on the effectiveness of intrawound vancomycin application to prevent postoperative SSI. RevMan 5.3 was used to compare the data extracted from the studies included.ResultsA total of 27 studies involving 17,321 patients were included in the final analysis. Among those patients, 7,423 patients were treated with vancomycin to prevent SSI, with 9,898 in control groups. SSI incidence after surgery in experimental groups was 0.39 times as high as control groups, and this difference was statistically significant (P<0.01). Among patients who underwent internal fixation, vancomycin application significantly reduced the incidence of postoperative SSI (OR 0.31 95% CI 0.19–0.50; P<0.01). Meanwhile, vancomycin did not affect SSI incidence in patients who did not receive internal fixation (P=0.17) or received deformity correction (P=0.25).ConclusionSSI incidence after spinal surgery can be significantly reduced by intrawound application of vancomycin in most circumstances. This method can be applied in various spinal procedures involving instrumentation to prevent postoperative SSI.

Wednesday, September 26, 2018 2:00 PM – 3:00 PM Increasing Value: Lumbar Spine Surgery: 65. Cost-effectiveness of vancomycin powder in lumbar laminectomy

BACKGROUND CONTEXT Intra-wound application of vancomycin powder has demonstrated dramatic reductions of infection rate following lumbar laminectomy and fusion. The economic benefit of this prophylactic protocol has been previously validated for laminectomy and fusion, but the cost-effectiveness is less clear for lumbar laminectomy alone. PURPOSE The goal of this study is to demonstrate that application of vancomycin powder is a cost-effective method for preventing infection following lumbar laminectomy. STUDY DESIGN/SETTING Break-even cost analysis. OUTCOME MEASURES This study determined the magnitude by which the rate of infection following lumbar laminectomy alone and lumbar laminectomy and fusion would need to be reduced by in order to make application of vancomycin powder cost effective. METHODS The product cost of vancomycin powder was obtained from our institution's purchasing records. Total charges for lumbar laminectomy and lumbar laminectomy and fusion, rates of infection, and cost of revision were obtained from the literature. A break-even analysis [break-even infection rate=(initial infection rate−cost of protocol)/cost of treatment] was then performed to determine the absolute risk reduction (ARR) in infection rate to make prophylactic application of vancomycin powder cost effective. RESULTS Costing $3.06 per gram at our institution, vancomycin powder was determined to be cost-effective in lumbar laminectomy if the infection rates of 4.2% decreased by an ARR of 0.015%. Laminectomy and fusion was also determined to be cost effective at the same cost of vancomycin powder if the infection rate of 8.5% decreased by an ARR of 0.0034%. At the current highest cost reported in the literature, $44.00 per gram of vancomycin powder remained cost-effective with respective ARRs of 0.21% and 0.048% for laminectomy and laminectomy and fusion. Varying the baseline infection rate did not influence the ARR for either procedure when the analysis was performed using the product cost of vancomycin at our institution. CONCLUSIONS This break-even analysis demonstrates that prophylactic intra-wound application of vancomycin powder can be highly cost effective not only for lumbar laminectomy and fusion, but also for laminectomy alone. At our institution's price point, use of vancomycin powder is economically justified if it prevents at least one infection out of 6,700 lumbar laminectomy surgeries. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

ADVERSE DRUG REACTIONS TO LOCAL INTRAWOUND VANCOMYCIN APPLICATION AFTER POSTERIOR LUMBOSACRAL FUSION

Objective. To analyze the types and frequency of adverse drug reactions to local intrawound application of vancomycin powder in patients after posterior decompression and stabilization in the lumbosacral spine. Material and Methods . Clinical series published in 2011–2017 were analyzed. At the first stage, Medline and PubMed databases were searched for English-language literature sources using the keywords «intrawound vancomycin», «surgical site infection», and «posterior lumbar fusion», and e-Library for Russian-language sources using «local application of vancomycin powder», «infection in the surgical site», and «posterior decompression and stabilization». At the second stage, abstracts of articles were examined, and publications that did not meet the research criteria were excluded. At the third stage, the full texts of the selected articles were reviewed for compliance with inclusion criteria, as well as references for relevant studies. Results. Nineteen clinical studies (16 retrospective and 3 prospective) with a total of 13,077 patients were selected for a systematic review. In 55.3 % (7,236) of posterior lumbosacral surgery cases, vancomycin powder was applied locally to prevent surgical site infection. Among the entire cohort of patients, unwanted drug reactions were detected in 2.19 % of patients. Conclusions. Local application of vancomycin powder is associated with a low incidence of unwanted drug reactions.

Reduction in surgical site infection with suprafascial intrawound application of vancomycin powder in instrumented posterior spinal fusion: a retrospective case-control study.

OBJECTIVE Recent studies have demonstrated the efficacy of subfascial intrawound application of vancomycin powder in spine surgery in reducing the rate of surgical site infections (SSIs). However, to date no study has evaluated the efficacy and safety of suprafascial application of vancomycin powder in spine surgery. The purpose of this study was to quantify the rate of SSIs after open instrumented posterior spinal fusion with and without application of suprafascial vancomycin powder and to evaluate the rate of vancomycin powder-related local adverse effects. METHODS The authors conducted a single-center retrospective case-control study of adult patients undergoing open instrumented posterior fusion of the cervical, thoracic, or lumbar spine performed by a single surgeon from January 2010 through December 2016. In March 2013, routine application of 1 g of suprafascial vancomycin powder was started for all cases in addition to standard systemic antibiotic prophylaxis. Baseline demographics and operative data as well as the SSI rates were compared between the study groups. The incidence of vancomycin powder-related adverse effects was analyzed. RESULTS A total of 515 patients (268 in the untreated group and 247 in the treated group) were included in the study. The mean age was significantly higher in the treated group than in the untreated group (58.4 vs 54.4 years, p < 0.01). Operative variables were similar between the study groups. Patients receiving vancomycin powder had a significantly lower infection rate (5.6% in the untreated group vs 0% in the treated group, p < 0.001). No vancomycin powder-related adverse effects were identified in the treated group. CONCLUSIONS Routine application of suprafascial intrawound vancomycin powder in addition to systemic antibiotic prophylaxis is an easy-to-use, safe, and effective strategy for preventing SSIs after instrumented posterior spinal fusion. Suprafascial application of vancomycin powder could be a valuable alternative to previously reported subfascial distribution, minimizing the risk of local adverse drug reactions.

Red man syndrome caused by vancomycin powder

Red man syndrome (RMS) is a well-known hypersensitivity reaction caused by intravenous administration of vancomycin, with symptoms ranging from flushing, erythematous rash, pruritus, mild to profound hypotension, and even cardiac arrest. RMS has not previously been described from local application of vancomycin powder in a surgical wound, a technique increasingly utilized for infection prophylaxis in many surgical disciplines including neurosurgery. We describe the first reported case of RMS as a result of local intra-wound application of vancomycin powder for infection prophylaxis. A 73-year-old male with a history of Parkinson’s disease underwent 2-stage deep brain stimulation implantation surgeries. Vancomycin powder was applied locally in the surgical wounds for infection prophylaxis during both of the surgeries. The patient developed a well-demarcated, geometric erythematous pruritic rash following the second surgery that was clinically diagnosed as RMS and resolved without sequelae.

HCP-22TOPICALLY APPLIED VANCOMYCIN POWDER REDUCES THE RATE OF SURGICAL SITE INFECTION IN PATIENTS UNDERGOING CRANIOTOMIES FOR PRIMARY BRAIN TUMORS

BACKGROUND: Surgical site infections (SSI) can increase postoperative morbidity, mortality and lead to increased health care costs. The rates of SSI can be as high as 5.8% in patients undergoing craniotomies for tumors. Local application of vancomycin powder has been shown to be effective in reducing SSI in spine surgery; however, the effectiveness and safety of vancomycin powder in craniotomy in unclear. METHODS: The authors performed a retrospective chart review of all patients who underwent craniotomies for resection of primary brain glioma at the Moffitt Cancer Center from 2004-2014. A protocol consisting of 1 g of intrawound vancomycin powder application was initiated at our institution in 2010. Patient demographics (age, gender), clinical characteristics (comorbidities, steroid dose, KPS), tumor characteristics (tumor type, location), surgical factors (primary or redo, length of surgery, blood loss), SSI rates were assessed. Multivariate analysis was performed to determine risk factors associated with SSI and rates. RESULTS: A total of 864 patients underwent craniotomies for primary brain tumors. The cohorts were similar in demographics and baseline comorbidities, KPS, tumor characteristics, and surgical factors. SSI rates at 90 days were reduced after the implementation of vancomycin powder. CONCLUSIONS: The use of vancomycin powder application in craniotomy led to a reduction in SSI. No significant adverse events were observed.

Intrawound Vancomycin Powder for Spine Tumor Surgery.

Study Design Retrospective evaluation of prospectively collected data. Objective To evaluate infection rates following intrawound vancomycin powder application during spine tumor surgery. Methods Patients ≥18 years old undergoing spine tumor surgery and receiving intrawound vancomycin powder at a single center between January 2008 and January 2015 were enrolled. Patient demographics (age, sex, body mass index [BMI]), tumor type (metastatic, primary) and location, surgical data (estimated blood loss [EBL], levels fused, type of decompression, length of surgery and hospitalization, discharge status from hospital), radiation therapy use, and infection rates (surgery to a minimum of 30 days postoperative) were evaluated. Results Forty patients (46 procedures) undergoing spine tumor surgery and intrawound vancomycin powder application were identified. Five were excluded because of death less than 30 days postoperatively, and 35 patients (41 procedures) were enrolled: 11 women and 24 men with an average age of 61.4 years (range 19 to 92) and average BMI of 27.3 (range 17.4 to 36.8). Three cases were primary spine tumors. Five were hematologic malignancies, and 27 were metastatic cancers. Twenty-one tumors were in the thoracic spine, 12 in the lumbar spine, and 8 in the cervical spine. Average EBL was 899 mL (range 25 to 3,500), average length of surgery was 241 minutes (range 78 to 495), and average hospital stay was 15.1 days (range 3 to 49). Two culture-proven infections (Staphylococcus aureus, Enterobacter cloacae) were noted in 41 procedures (4.9%). Ten patients (28.6%) had preoperative radiation only; 14 (40%) had postoperative radiation only, 5 (14.3%) had both preoperative and postoperative radiation, and 6 (17.1%) had no radiation. There were no associations between radiation treatment and postsurgical infections (p = 0.19). Conclusion In this first study evaluating intrawound vancomycin powder for spine tumor surgery, we report an infection rate of 4.9%. We found no correlations between radiation treatment and postsurgical infections.

Reducing surgical site infection in spinal surgery with betadine irrigation and intrawound vancomycin powder.

Retrospective analysis. The objective of this study was to evaluate the efficacy of a surgical site infection (SSI) prevention protocol instituted in the Orthopaedic Spine Department at our institution. SSI is an undesired complication of orthopedic spine surgical procedures. It poses a significant risk to the patient, as well as a financial toll on the health care system. A wide range of prophylactic measures have been used to attempt to reduce SSI rates. A protocol consisting of a combination of 0.3% Betadine wound irrigation and 1 g of intrawound Vancomycin powder application was developed at our institution. Multiple data sources were consolidated for thorough evaluation of changes in SSI rates, patient risk factors, and changes in bacteriology. Identification of risk factors that predispose patients to SSI was performed using mixed-effects logistic regression in a univariate fashion. Risk factors with P values of 0.05 or less in univariate analysis were included together in a multivariate mixed-effects logistic regression model. SSI rates were reduced by 50% after the intervention; χ analysis comparing the SSI rates between the pre- and postintervention periods yielded a P value of 0.042. Rates of methicillin-resistant Staphylococcus aureus dropped from 30% to 7% and the rates of multibacterial infections dropped from 37% to 27%. The risk factors that were statistically significant in multivariate analysis were the following: age (odds ratio [OR] = 0.93), anemia (OR = 30.73), prior operation (OR = 27.45), and vertebral fracture (OR = 22.22). The combination of Betadine wound irrigation and intrawound vancomycin powder application led to both a clinically and statistically significant decrease in SSI rates by 50%. Bacteriology analysis and risk factor assessment proved to be valuable tools in assessing the efficacy of a new prophylactic measure and in the planning of future protocols. 4.

Application de poudre de vancomycine sur le champ opératoire combiné à l’administration intraveineuse d’antibiotiques : une méta-analyse des infections profondes du site après chirurgie rachidienne

BackgroundThe intrawound application of vancomycin powder in addition to intravenous administration of antibiotics has been reported to be an easy and cost-efficient technique for reducing the deep infection, which is a serious complication of spinal surgeries. The aim of the present meta-analysis was to derive a preliminary estimation on the clinical performance of this technique. HypothesisThe intrawound application of vancomycin powder in addition to intravenous administration of antibiotics may significantly reduce the risk of deep infection after spinal surgeries. Materials and methodsStudies were identified from PubMed and EMBASE searches. After comprehensive review, data were extracted from eligible studies. A meta-analysis was performed to generate pooled odds ratio (OR) of this technique. ResultsEight studies (4592 patients) were included. The pooled OR (95 %CI) was 0.22 (0.07–0.63). I2 value was 65.2 % (P=0.005). The pooled ORs were stable in sensitivity analyses. No analysis of subgroup, meta-regression or publication bias was performed because of inadequate included studies. DiscussionThe intrawound application of vancomycin powder in addition to intravenous administration of antibiotics may significantly reduce the risk of deep infection after spinal surgeries. Further studies with large sample size and high quality are needed to provide more evidences. Level of evidenceII.

Topical intrawound application of vancomycin powder in addition to intravenous administration of antibiotics: A meta-analysis on the deep infection after spinal surgeries

BackgroundThe intrawound application of vancomycin powder in addition to intravenous administration of antibiotics has been reported to be an easy and cost-efficient technique for reducing the deep infection, which is a serious complication of spinal surgeries. The aim of the present meta-analysis was to derive a preliminary estimation on the clinical performance of this technique. HypothesisThe intrawound application of vancomycin powder in addition to intravenous administration of antibiotics may significantly reduce the risk of deep infection after spinal surgeries. Materials and methodsStudies were identified from PubMed and EMBASE searches. After comprehensive review, data were extracted from eligible studies. A meta-analysis was performed to generate pooled odds ratio (OR) of this technique. ResultsEight studies (4592 patients) were included. The pooled OR (95% CI) was 0.22 (0.07–0.63). I2 value was 65.2% (P=0.005). The pooled ORs were stable in sensitivity analyses. No analysis of subgroup, meta-regression or publication bias was performed because of inadequate included studies. DiscussionThe intrawound application of vancomycin powder in addition to intravenous administration of antibiotics may significantly reduce the risk of deep infection after spinal surgeries. Further studies with large sample size and high quality are needed to provide more evidences. Level of evidenceII.

Lumbar laminectomy and fusion with routine local application of vancomycin powder: Decreased infection rate in instrumented and non-instrumented cases

ObjectiveWound infections are one of the most common and potentially devastating complications of spinal surgery. Intra-wound application of vancomycin powder has been shown to lower the infection risk following posterior instrumented fusion, but little evidence supports use in other spinal operations. The goal of this study is to assess the efficacy of vancomycin powder for lumbar laminectomy and fusion, both instrumented and non-instrumented. MethodsAll cases of lumbar laminectomy and posterior fusion (with or without pedicle screw fixation) by a single surgeon were reviewed from 2007 to 2011. Routine application of 1g vancomycin powder was started in August 2009. Baseline characteristics and operative data were compared between untreated patients and those who received vancomycin powder. Rates of wound infection were compared for all fusions, and then separately for instrumented and non-instrumented cases. Results253 patients underwent lumbar laminectomy and fusion between 2007 and 2011. Baseline and operative variables were similar between untreated patients (n=97) and those who received vancomycin powder (n=156). Patients were followed for at least one year. The infection rate fell significantly following introduction of vancomycin powder (from 11% to 0%, p=0.000018). Subgroup analysis revealed significant infection reduction for both instrumented cases (from 12% to 0%, p=0.000806) and non-instrumented cases (from 10% to 0%, p=0.0496). No complications attributable to vancomycin powder were identified. ConclusionLocal vancomycin powder appears to lower the risk of wound infection following lumbar laminectomy and fusion, both instrumented and non-instrumented. Further studies are needed to optimize dosing of vancomycin powder, assess long-term safety and efficacy, and evaluate use in other spinal operations.

Prophylactic intrawound application of vancomycin powder in instrumented spinal fusion surgery.

ObjectiveWe evaluated the effect of intrawound application of vancomycin powder for infection prophylaxis in wounds caused by instrumented spinal surgery.MethodsFrom July 2012 to December 2012, 74 instrumented spinal fusion procedures were performed by 1 neurosurgeon at a single institute. We divided the patients into 2 groups, depending on the use of local application of vancomycin powder: Group A (intrawound application of vancomycin powder with perioperative intravenous cefazolin) and Group B (perioperative intravenous cefazolin alone). A retrospective cohort comparative study was conducted between the 2 groups. The age, sex, comorbidities, smoking, surgical procedure, and surgical site infection (SSI) of consecutive patients were analyzed.ResultsAmong the 74 patients, 34 patients were assigned to group A and 40 patients to group B. No wound infections were found in group A. However, in group B, 5 cases of SSI (12.5%) were found. A statistically significant reduction in SSI incidence was observed in group A (p<0.033). The 5 cases of SSI in group B consisted of 3 cases of deep wound infection and 2 cases of superficial wound infection. All SSIs were found in cases of posterior approach surgery and tended to be more frequent in older patients.ConclusionAdjunctive intrawound local application of vancomycin powder is a simple uncomplicated procedure and can result in a significant reduction of SSI in instrumented spinal fusions. Furthermore, culture of the drainage tip is very important for confirmation of deep wound infection.