Vancomycin Group Research Articles

Powdered Vancomycin as Preventive Treatment in Lumbar Surgical Wound Infection

Summary: Due to its pharmacodynamic capabilities and its properties at the cell membrane level, vancomycin is considered one of the glycopeptides for clinical use as first-line treatment against most Gram-positive germs. Objective: To analyze the efficacy of topical vancomycin in the prevention of infections at the surgical wound level in spinal surgery. Material and methods: A non-randomized, observational and comparative cohort study of 60 patients with instrumented lumbar spine surgery was carried out in the period between June 2021 and june 2022. In 30 cases with placement of 1 g of topical vancomycin group 1, and 30 did not Group 2, in a nonrandomized manner. Patients were followed up during the first 90 postoperative days. Results: The relationship between vancomycin-infection was not statistically significant, 3 cases of wound infection were identified in the group without vancomycin, it was found that the factor of age over 50 years and Diabetic or immunosuppressed and obesity were predisposing causes respectively, although without p ≤ 0.05, another finding was the RR 2.0208 in an instrumented lumbar level but without significant difference; the main characteristics in the 3 patients with wound infection were only present in the group without vancomycin, identifying. Conclusions: There is no statistical significance in our study that topical vancomycin plays a fundamental role in the prevention of infections at the surgical wound level in spinal surgery. However, it is important to note that all the infected patients in this study belonged to group 2 (without the use of vancomycin).

Is Vancomycin More Effective than Taurolidine? Comparative Analysis of Their Preventive Effect against Spinal Infection in 1000 Patients with Spinal Fusion.

This study aimed to examine the effect of taurolidine irrigation on preventing surgical site infection by comparing the spinal infection rate after spinal fusion surgery using vancomycin powder application and taurolidine irrigation. Of 1081 participants, 369 underwent taurolidine irrigation, 221 underwent vancomycin powder application, and 491 were controls. Of the 20 surgical site infections (1.85%), 14 occurred in the control group (2.85%), 5 in the vancomycin group (2.26%), and 1 (0.27%) in the taurolidine group. Among the various variables, age at the time of surgery, smoking, surgical site, and hemovac removal time were significant in the univariate logistic regression. The final result was derived after variable selection using the stepwise method. In the univariate model, the odds ratios were 0.09 and 0.79 in each of the vancomycin and taurolidine groups compared to that of the control group. In the multivariate model, the odds ratios were 0.09 and 0.83 in each of the vancomycin and taurolidine groups compared to that of the control group. The preventive effect of vancomycin powder application was not statistically significant. However, the vancomycin group showed a less effective tendency than the taurolidine group. Taurolidine irrigation may be a good substitute for the vancomycin powder application.

Does local vancomycin powder impregnated with autogenous bone graft and bone substitute decrease the risk of deep surgical site infection in degenerative lumbar spine fusion surgery?—An ambispective study

BackgroundDeep surgical site infection (DSSI) is one of the most challenging complications in lumbar fusion surgery. Few investigations examined the effect of vancomycin powder mixed with autogenic bone graft (ABG) and bone substitutes on preventing DSSI in degenerative lumbar fusion surgeries as well as any interference with bony fusion. The aim of the study was to investigate the effects of ABG along with bone substitutes as a local vancomycin delivery system on preventing DSSI in lumbar instrumented fusion and compared with those who did not use vancomycin powder.MethodsFrom January, 2015 through December, 2015, a one-year prospective study using vancomycin powder mixed with ABG and bone substitute for degenerative lumbar fusion surgeries as vancomycin (V) group, 1 gm vancomycin for 2 and 3-level, and 2 gm for more than 3-level instrumentation. From December, 2013 through December 2014, patients received degenerative lumbar fusion surgeries without using vancomycin before the vancomycin protocol were retrospectively enrolled as non-vancomycin (NV) group. Vancomycin concentration was checked at post-operative days 1 and 3 for both the serum and drainage. Patients’ demographic data, microbiology reports, fusion status and functional outcomes were evaluated.ResultsOne hundred and ten patients were enrolled prospectively in the V group, and 86 for the NV group. After an average 41 months follow-up (range, 36–54), 3 patients (3.48%) developed postoperative DSSIs in the NV group, thereby requiring revision surgeries and parenteral antibiotics treatment versus no DSSIs (0%, 0/100) in the V group. (p = 0.048). The postoperative serum vancomycin levels were undetectable and no vancomycin related side effects was encountered. The mean vancomycin concentration of drainage at postoperative days 1 and 3 were 517.96 ± 174.4 and 220.14 ± 102.3 μg/mL, respectively. At final follow-up, there was no statistical difference observed in terms of clinical and radiologic outcomes.ConclusionsOur vancomycin protocol may reduce the incidence of DSSI in degenerative lumbar fusion surgery without affecting bony fusion.Level of EvidenceLevel III ambispective comparative study.

Prophylactic Intrawound Vancomycin Powder in Minimally Invasive Spine Stabilization May Cause an Acute Inflammatory Response.

IntroductionSurgical site infections (SSIs) with methicillin-resistant Staphylococcus aureus are serious complications of spinal instrumentation surgery. Many spine surgeons are concerned that using prophylactic vancomycin powder will lead to certain risks: the development of multidrug-resistant pathogens, anaphylactic reactions, and organ toxicity. Minimally invasive spine stabilization (MISt) is associated with shorter operation times and less blood loss and may therefore require the use of less vancomycin powder, which may reduce these risks. This retrospective comparative study of patients who underwent MISt at a single institution aimed to evaluate the complications (such as allergy, SSIs, and organ toxicity) and the local and serum levels associated with using prophylactic intrawound vancomycin powder compared with IV cefazolin alone.MethodsThirty-four patients received intrawound vancomycin powder (1 g) applied during wound closure in minimally invasive posterior lumbar interbody fusion (MIS-PLIF). This group was compared with 133 control patients who did not receive vancomycin. White blood cell counts and C-reactive protein (CRP) levels were measured for both groups on postoperative days (PODs) 1, 3, and 7 and were statistically analyzed. In the vancomycin group, serum vancomycin levels were measured on PODs 1, 3, 7, and 14; drain vancomycin levels and postoperative blood loss were determined on PODs 1 and 2.ResultsThe CRP levels on PODs 1 and 3 were significantly higher in the vancomycin group than in the control group (P<0.001, P=0.024). In the vancomycin group, mean drain levels trended downward from 313 μg/mL (POD 1) to 155 μg/mL (POD 2). These levels correlated negatively with drain drainage volume on both days (POD 1: r=-0.48, P=0.015; POD 2: r=-0.47, P=0.019). Mean serum vancomycin levels also trended downward from 2.3 μg/mL (POD 1) to 1.7 μg/mL (POD 14).ConclusionsOur results unexpectedly demonstrated that the local application of vancomycin powder causes an acute inflammatory response and the long-term detection of low serum vancomycin levels. Less than 1 g of intrawound vancomycin powder may be useful only at high risk of SSI.

Blood Biomarkers and Metabolomic Profiling for the Early Diagnosis of Vancomycin-Associated Acute Kidney Injury: A Systematic Review and Meta-Analysis of Experimental Studies.

Background: several blood-based biomarkers have been proposed for predicting vancomycin-associated kidney injury (VIKI). However, no systematic analysis has compared their prognostic value. Objective: this systematic review and meta-analysis was designed to investigate the role of blood biomarkers and metabolomic profiling as diagnostic and prognostic predictors in pre-clinical studies of VIKI. Methods: a systematic search of PubMed was conducted for relevant articles from January 2000 to May 2022. Animal studies that administered vancomycin and studied VIKI were eligible for inclusion. Clinical studies, reviews, and non-English literature were excluded. The primary outcome was to investigate the relationship between the extent of VIKI as measured by blood biomarkers and metabolomic profiling. Risk of bias was assessed with the CAMARADES checklist the SYRCLE’s risk of bias tool. Standard meta-analysis methods (random-effects models) were used. Results: there were four studies for the same species, dosage, duration of vancomycin administration and measurement only for serum creatine and blood urea nitrogen in rats. A statistically significant increase was observed between serum creatinine in the vancomycin group compared to controls (pooled p = 0.037; Standardized Mean Difference: 2.93; 95% CI: 0.17 to 5.69; I2 = 92.11%). Serum BUN levels were not significantly different between control and vancomycin groups (pooled p = 0.11; SMD: 3.05; 95% CI: 0.69 to 6.8; I2 = 94.84%). We did not identify experimental studies using metabolomic analyses in animals with VIKI. Conclusions: a total of four studies in rodents only described outcomes of kidney injury as defined by blood biomarkers. Blood biomarkers represented included serum creatinine and BUN. Novel blood biomarkers have not been explored.

The effect of single dose prophylactic vancomycin before semi-permanent catheterization to prevent catheter related infection; a randomized controlled trial, phase II

Introduction: Catheter-related infections are a common complication and a major cause of morbidity and mortality in hemodialysis patients with tunneled central venous catheters. The optimal strategy for the management and prevention of catheter-related infections is unclear. Objectives: This study is aimed to evaluate the single-dose prophylactic vancomycin efficacy before semi-permanent catheterization to prevent catheter-related infection. Patients and Methods: This randomized double-blind controlled clinical trial was conducted on patients with chronic renal failure requiring hemodialysis and insertion of a double-lumen central venous catheter admitted to Ahvaz Golestan Hospital. The intervention group (n=30) received 1 g of vancomycin intravenously one hour before catheter insertion and the control group (n=30) received an equal amount of normal saline. The incidence of catheter-related infections and other complications for 6 months was evaluated. Results: During the 6-month follow-up, hospitalization due to catheter-related infection and the need for antibiotic administration was observed in 9 patients (30.0%) who received vancomycin and 14 patients (46.7%) in the control group (P=0.184). Catheter extraction due to infection was observed in 4 patients of the vancomycin group (13.3%) and 6 patients of the control group (20.7%) (P=0.451). Complications other than infection were observed in four patients (13.3%) in each group (P=1.000). The mean time to onset of infection was 2.43 ±0.38 months in the control group and 3.85 ± 0.42 months in the vancomycin group (P=0.002). Conclusion: Although a single dose of intravenous vancomycin one hour before insertion of a bi-luminal hemodialysis catheter did not show a significant effect on preventing catheter-related infections over 6 months, it significantly delayed the onset of infection. Trial Registration: The trial protocol was approved by Iranian Registry of Clinical Trial (Ethical code: IR.AJUMS.HGOLESTAN.REC.1399.106 and IRCT code: IRCT20201206049617N1; https://www.irct.ir/trial/52832).

Gut Microbiome Is Associated With the Response to Chemoradiotherapy in Patients With Non-small Cell Lung Cancer

To explore the dynamic change of gut microbiota and its predictive role in progression-free survival (PFS) in non-small cell lung cancer (NSCLC) after concurrent chemoradiotherapy (CCRT). Forty-one patients with NSCLC in 2 phase 2 trials (NCT02573506 and NCT03006575) were analyzed. A total of 102 fecal samples were collected at 3 time points (T0, before CCRT; T1, 2 weeks after the initiation of CCRT; and T2, the end of CCRT). Gut microbiota composition and functionality were analyzed by 16S rRNA gene sequencing and shotgun metagenomics, respectively. Alpha diversity, taxonomic composition, and KEGG functional pathways were compared between patients in the long-PFS group (PFS ≥11.0 months) and short-PFS group (PFS <11.0 months). A random forest classifier was constructed to identify microbial signature related to PFS. Clinical and microbial factors potentially predictive of PFS were assessed in the univariate and multivariate Cox regression analysis. The abundance of Bacteroidota and Proteobacteria increased, while the abundance of Firmicutes decreased after CCRT. Shannon index (P=.006) and PD index (P=.022) were significantly higher in the long-PFS group than for those in the short-PFS group at T1. The PFS-prediction microbial signature at T1 included unclassified members of the Lanchospiraceae spp., such as NK4A136 and UCG-003 groups, Dorea sp., various strains from within the Eubacterium hallii and E. siraeum groups, and an unclassified member of the Muribaculaceae, which yielded an area under the ROC curve of 0.87. These discriminatory genera mostly belong to phylum Firmicutes/family Clostridia. Multivariate analysis indicated PD index (HR=8.036, P=.016) and the abundance of Dorea sp. at T1 (HR=4.186, P=.043) were independent predictors of PFS. The KEGG pathways at T1 overrepresented in the long-PFS group included fatty acid metabolism, fatty acid biosynthesis, and arginine biosynthesis. Those overrepresented in the short-PFS group included lipopolysaccharide biosynthesis, ascorbate and aldarate metabolism, and biosynthesis of vancomycin group antibiotics. Gut microbiota composition and functionality at 2 weeks after the initiation of CCRT were associated with PFS in NSCLC. Further research is needed to confirm these results.

Comparison of mortality and clinical failure rates between vancomycin and teicoplanin in patients with methicillin-resistant Staphylococcus aureus pneumonia

BackgroundVery few studies have compared the effects and side effects of vancomycin and teicoplanin in patients with methicillin-resistant Staphylococcus aureus pneumonia. This study aimed to compare the efficacy and safety of vancomycin and teicoplanin in patients with methicillin-resistant Staphylococcus aureus pneumonia.MethodsThis study examined 116 patients with methicillin-resistant Staphylococcus aureus pneumonia who met the inclusion criteria and were treated with either vancomycin (n = 54) or teicoplanin (n = 62). The primary (i.e., clinical failure during treatment) and secondary outcomes (i.e., mortality rates, discontinuation of study drugs due to treatment failure, side effects, and clinical cure) were evaluated.ResultsThe vancomycin group presented lower clinical failure rates (25.9% vs. 61.3%, p < 0.001), discontinuation due to treatment failure (22.2% vs. 41.9%, p = 0.024), and mortality rates (3.7% vs 19.4%, p = 0.010). The Cox proportional hazard model revealed that teicoplanin was a significant clinical failure predictor compared with vancomycin (adjusted odds ratio, 2.198; 95% confidence interval 1.163–4.154). The rates of drug change due to side effects were higher in the vancomycin group than in the teicoplanin group (24.1% vs. 1.6%, p < 0.001).ConclusionsVancomycin presented favorable treatment outcomes and more side effects compared with teicoplanin, which suggests that clinicians would need to consider the efficacy and potential side effects of these drugs before prescription.

Efficacy of teicoplanin in bloodstream infections caused by Enterococcus faecium: posthoc analysis of a nationwide surveillance

ObjectivesVancomycin and teicoplanin are glycopeptides with activity against Enterococcus faecium. However, studies on the clinical efficacy of teicoplanin are limited. This study aimed to compare the therapeutic efficacy of teicoplanin and vancomycin in E. faecium bacteremia. MethodsWe identified patients with bloodstream infections prospectively from July 2015 to December 2016 in 14 hospitals as part of a multicenter nationwide surveillance. Patients with E. faecium monomicrobial bacteremia were selected. Teicoplanin and vancomycin groups included patients treated with either agent for ≥48 hours. The primary outcome was 30-day all-cause in-hospital mortality. The Cox proportional hazards model with inverse probability weighting was used to account for the imbalance in baseline characteristics between the two groups. ResultsAmong 97 patients with E. faecium bacteremia, 33 (34%) were treated with teicoplanin and 64 (66%) with vancomycin. There were no significant differences in 30-day in-hospital mortality (18.2% vs 26.6%, P = 0.358) and 7-day mortality (6.1% vs 15.6%, P = 0.212). Furthermore, multivariable analysis confirmed that the use of teicoplanin was not significantly associated with mortality (adjusted odds ratio, 0.72; 95% confidence interval, 0.28-1.86; P = 0.494). ConclusionWe found no significant differences in the clinical outcomes. These findings suggest teicoplanin as a useful alternative to vancomycin.

Intra-articular versus systemic vancomycin for the treatment of periprosthetic joint infection after debridement and spacer implantation in a rat model.

AimsTreatment outcomes for methicillin-resistant Staphylococcus aureus (MRSA) periprosthetic joint infection (PJI) using systemic vancomycin and antibacterial cement spacers during two-stage revision arthroplasty remain unsatisfactory. This study explored the efficacy and safety of intra-articular vancomycin injections for PJI control after debridement and cement spacer implantation in a rat model.MethodsTotal knee arthroplasty (TKA), MRSA inoculation, debridement, and vancomycin-spacer implantation were performed successively in rats to mimic first-stage PJI during the two-stage revision arthroplasty procedure. Vancomycin was administered intraperitoneally or intra-articularly for two weeks to control the infection after debridement and spacer implantation.ResultsRats receiving intra-articular vancomycin showed the best outcomes among the four treatment groups, with negative bacterial cultures, increased weight gain, increased capacity for weightbearing activities, increased residual bone volume preservation, and reduced inflammatory reactions in the joint tissues, indicating MRSA eradication in the knee. The vancomycin-spacer and/or systemic vancomycin failed to eliminate the MRSA infections following a two-week antibiotic course. Serum vancomycin levels did not reach nephrotoxic levels in any group. Mild renal histopathological changes, without changes in serum creatinine levels, were observed in the intraperitoneal vancomycin group compared with the intra-articular vancomycin group, but no changes in hepatic structure or serum alanine aminotransferase or aspartate aminotransferase levels were observed. No local complications were observed, such as sinus tract or non-healing surgical incisions.ConclusionIntra-articular vancomycin injection was effective and safe for PJI control following debridement and spacer implantation in a rat model during two-stage revision arthroplasties, with better outcomes than systemic vancomycin administration.Cite this article: Bone Joint Res 2022;11(6):371–385.

What's New in Orthopaedic Trauma.

What's New in Orthopaedic Trauma.

A comparison of low-dose teicoplanin-loaded spacer application vs. high-dose vancomycin-and-gentamicin-loaded spacer application in the treatment of periprosthetic knee infection

Background/purpose In the current study, our aim was to compare the efficacy and biocompatibility of teicoplanin-loaded and vancomycin-and-gentamicin-loaded articulating spacers used in two-stage revision arthroplasty for eradication of periprosthetic knee joint infection. Methods In the current retrospective cohort study, there were 24 patients who were given 2 g or less antibiotics per 40 g of cement in the low-dose teicoplanin group, and 20 patients who were given a total of 3.6 g or more antibiotics per 40 g of cement in the high-dose vancomycin and gentamicin group. Two groups were compared statistically. Results There was no statistically significant difference in the treatment failure between the two groups (p = 0.488). No statistically significant differences were found in spacer fracture rates between the two groups (p = 0.802). Conclusion The current study has demonstrated that low-dose teicoplanin protocol is as effective and safe as high-dose vancomycin and gentamycin protocol.

THE FREQUENCY AND MICROBIOLOGICAL CHARACTERISTICS OF BACTERIA CAUSING SEPTIC SHOCK AT NGHE AN GENERAL FRIENDSHIP HOSPITAL

Abstract: Objectives: To determine the frequency and microbiological characteristics of bacteria causing septic shock in patients with positive blood culture results. Methods: Cross-sectional descriptive study. Results: Total 100 patients diagnosed with septic shock had positive blood culture results at Nghe An General Friendship Hospital from January 2020 to December 2020. The mean age was 67.06 ± 16.42 years old. There were 57 patients ≥ 65 years old, accounting for 57%, more common than patients &lt; 65 years old (43 patients with a rate of 43%). The proportion of Gram-negative bacteria (66%) was higher than Grampositive bacteria (34%). The respiratory tract infection (52%) was the most common source, followed by the intra-abdominal infection (23%) and the urinary tract infection (10%). E. coli was the most common pathogen (32%), followed by S. aureus (26%) and K. pneumoniae (11%). Among patients with diabetes and COPD, the most common pathogens were E. coli, S. aureus and Enterococcus faecalis. Most of the antibiotic groups were been resistant, especially cephalosporin antibiotics from 37.5% to 82.6%. Amikacin, fosmycin, vancomycin and linezolid groups were susceptible to bacteria. Conclusion: E. coli and S. aureus were two common pathogens in patients with septic shock. In particular, E. coli, S. aureus and Enterococcus faecalis were the common agents of septic shock among patients with diabetes and COPD. Amikacin, Fosmycin, Vancomycin and Linezolid groups were still susceptible to bacteria. Key words: septic shock, E. coli, S. aureus.

Gut Microbiota Alteration Influences Colorectal Cancer Metastasis to the Liver by Remodeling the Liver Immune Microenvironment

Background/AimsThis study aimed to explore the effect of gut microbiota-regulated Kupffer cells (KCs) on colorectal cancer (CRC) liver metastasis.MethodsA series of in vivo and in vitro researches were showed to demonstrate the gut microbiota and its possible mechanism in CRC liver metastasis.ResultsFewer liver metastases were identified in the ampicillin-streptomycin-colistin and colistin groups. Increased proportions of Parabacteroides goldsteinii, Bacteroides vulgatus, Bacteroides thetaiotaomicron, and Bacteroides uniformis were observed in the colistin group. The significant expansion of KCs was identified in the ampicillin-streptomycin-colistin and colistin groups. B. vulgatus levels were positively correlated with KC levels. More liver metastases were observed in the vancomycin group. An increased abundance of Parabacteroides distasonis and Proteus mirabilis and an obvious reduction of KCs were noted in the vancomycin group. P. mirabilis levels were negatively related to KC levels. The number of liver metastatic nodules was increased in the P. mirabilis group and decreased in the B. vulgatus group. The number of KCs decreased in the P. mirabilis group and increased in the B. vulgatus group. In vitro, as P. mirabilis or B. vulgatus doses increased, there was an opposite effect on KC proliferation in dose- and time-dependent manners. P. mirabilis induced CT26 cell migration by controlling KC proliferation, whereas B. vulgatus prevented this migration.ConclusionsAn increased abundance of P. mirabilis and decreased amount of B. vulgatus play key roles in CRC liver metastasis, which might be related to KC reductions in the liver.

Effects of linezolid on the haematological system in very low birth weight infants: A single-centre retrospective study.

Linezolid, as a substitute for vancomycin, has been used in treating methicillin-resistant Gram-positive bacterial infections in very low birth weight (VLBW) infants. However, when linezolid induces thrombocytopenia in adults, its side effects in VLBW infants are concerning. This study aimed to investigate the effect of linezolid on haematologic profiles in this specific vulnerable population. VLBW infants treated with linezolid from January, 2017, to July, 2021, were retrospectively analysed compared with vancomycin as controls. The effects of medications on haematologic parameters were compared on Days 1, 3, 5, 7, 10, 14 and 21 after medication initiation. Totally 40 VLBW infants treated with linezolid were recruited in the study, using 45 VLBW treated with vancomycin as controls. Baseline clinical characteristics, such as gestational age and birth weight, were not significantly different between the two groups. After medication initiation, the white blood cell counts on the Days 5 and 7 in the linezolid group were significantly lower than that in the vancomycin group (D5: 11.6±6.2*10⁹/L vs. 14.5±6.4*10⁹/L, p=0.013; D7: 10.8±5.9*10⁹/L vs. 14.1±8.0*10⁹/L, p=0.01), while the platelet counts were significantly lower in the linezolid group on Days 10 and 14 (D10: 219.2±90.5*10⁹/L vs. 287.5±100.4*10⁹/L, p=0.049; D14: 263.0±110.9*10⁹/L vs. 325.0±155.1*10⁹/L, p=0.036). For substantial haematologic abnormalities, there were no significant differences in leukopenia, neutropenia, agranulocytosis and thrombocytopenia between the two groups. In VLBW infants, compared with vancomycin, linezolid tends to induce lower white blood cell and platelet counts transiently, but does not increase the severe forms of haematologic side effects.

Efficacy of topical vancomycin application in cardiac surgery to reduce deep sternal wound infection: a randomised control trial at tertiary cardiac care hospital

Background: Mediastinitis is lethal complication and a challenge in post cardiac surgery patients. We aim at evaluation of topical vancomycin by applying it at sternal edge in prevention of deep sternal wound infection.Methods: The vancomycin group had local application of vancomycin paste prepared by mixing 1gm of powder in 3 ml of normal saline and stirred until paste was formed. The control group had reinforced closure technique without vancomycin paste application. All cases were followed up for symptoms and signs of sternal wound infection during hospital stay and uptil 1 month.Results: There was increase incidence of wound infection with control group as compared to vancomycin group, there were no wound infection in patients of vancomycin group.Conclusions: Application of topical vancomycin significantly reduces post-sternotomy wound infection and prevents deep mediastinitis.

Non-inferiority of metronidazole to vancomycin in the treatment of first episode non-severe Clostridioides difficile infection: a single center retrospective cohort study.

We sought to assess the effectiveness of oral vancomycin compared to metronidazole on recurrence and mortality among hospitalized patients with non-severe Clostridioides difficile infection (CDI). A single center retrospective cohort study was conducted, including adult patients hospitalized between 2015 and 2020 with a first episode of non-severe CDI, treated with metronidazole or vancomycin as monotherapy for at least 10days. We assessed recurrence of CDI requiring hospitalization (primary outcome) and all-cause mortality up to 8weeks, post discharge. Overall, 160 patients were treated with vancomycin and 149 treated with metronidazole. Re-hospitalization within 8weeks due to CDI occurred in 10 (6.2%) patients in the vancomycin group, and 13 (8.7%) in the metronidazole group (P value = 0.407). Eight-week mortality occurred in 39 patients (26.2%) in the metronidazole group and 46 patients (28.8%) in the vancomycin group (P value = 0.61). After adjusting for age, gender, Ischemic heart disease, white blood cell count, neutrophile count and CRP, there was no significant difference between the two treatments (Re-hospitalization in 8weeks due to CDI P = 0.5059; In-hospital death P = 0.7950; 4-week mortality P = 0.2988; 8-week mortality P = 0.8237). There is no benefit of using vancomycin compared to metronidazole concerning recurrence rate requiring hospitalization, in-hospital and up to 4- and 8-week mortality rate in non-severe first episode of CDI.

Role of intra-discal Vancomycin instillation in prevention post-operative discitis

BackgroundPost discectomy discitis is regarded as the most disabling cause of failed back surgery. Value of local intra-operative application of antibiotics in prevention of such complication has been a matter of debate. We evaluate the role of intraoperative intra-discal vancomycin powder instillation as a prophylaxis in prevention of postoperative discitis in patients undergoing microscopic discectomy. We allocated 100 patients undergoing discectomy equally into two groups. In the first group, a local Vancomycin powder was inserted into the disc space after finishing discectomy, and in the second group, nothing was inserted.ResultsThe postoperative discitis was reported in 6 cases; of them, two patients were in the Vancomycin group (4%), while four patients were in the non-Vancomycin group (8%).ConclusionsWe concluded that the intra-operative prophylaxis, with intra-discal Vancomycin, decreased the incidence of postoperative discitis but without significant statistical difference. We advocate using local vancomycin especially in high risk patients for prevention of post discectomy discitis.

Hemodialysis Catheter-Related Infections: Incidence in Temporary Catheters locked with Vancomycin and Heparin vs. Heparin-only

Background: The increasing incidence of end stage renal disease (ESRD) patients initiating hemodialysis (HD) through a temporary HD catheter has caused the rise in catheter related infections and associated morbidity and mortality. An antibiotic lock solution (ALS) for the prevention of catheter-related bacteraemia is a promising strategy. The present randomized control study has evaluated the efficacy and safety of vancomycin as an ALS in 54 patients who required temporary double lumen catheters for HD.&#x0D; Methods: The patients were randomized to receive either (A) an ALS (vancomycin 5 mg/ml + heparin 5000 IU/ml) – group A; or (B) unfractionated heparin (5000 IU/ml) alone as a catheter lock control – group B. The study duration was of three months and was conducted at the Department of Nephrology, PIMS, Islamabad.&#x0D; Results: The primary endpoint of the study was catheter related blood stream infection (CRBSI). The vancomycin group (A) had one episode of infection (CRBSI rate = 1.23/1000 days) compared with six episodes in the heparin-locked control group (B) (CRBSI rate = 8.55/1000 days). Mean catheter survival was significantly (p&lt;0.05) more in group A (30.48 ± 5.7days) compared to group B (26 ± 6.5 days). No thrombotic episodes or side effects were recorded.&#x0D; Conclusion: Vancomycin appeared to be a safe and effective ALS, preventing CRBSI and increasing survival of catheter in HD patients.

Berberis aristata reduces vancomycin-induced nephrotoxicity by down-regulation of cell proliferation markers

IntroductionVancomycin is used to treat bacterial infections but there is a risk of nephrotoxicity associated with it. Oxidative stress is the possible cause of this nephrotoxicity. Plant extracts have long been used in fighting oxidative stress and have proved quite useful. The present study investigated the treatment potential of Berberis aristata root extract against nephrotoxicity induced by vancomycin. MethodsB. aristata was collected from Chikar Valley, Azad Kashmir, identified, and later analyzed by High-pressure liquid chromatography (HPLC). Vero cells were used to determine the effects of B. aristata extract. For the determination of apoptotic and anti-inflammatory effects cells were divided into three major groups; Control, Vancomycin, and Treated. The control groups were either left untreated or treated with 0.1% DMSO. Vancomycin group was treated with 0.6 mg/mL, 3 mg/mL, and 6 mg/mL of vancomycin, while treated groups were treated with (100 µg/mL, 200 µg/mL, 400 µg/mL) along with various vancomycin (0.6 mg/mL, 3 mg/mL, and 6 mg/mL) concentrations. The mRNA expression of antioxidant and proliferative markers (p53, p21, Cas 4, Cas 5, Cas 9, and Cyt-c) was assessed by qPCR. ResultsHPLC chromatogram indicated the presence of berberine component by comparing the peaks at retention time. The mRNA expression of all selected markers was found to be upregulated in the vancomycin group with a decrease of expression in treated groups, indicating the recovery from vancomycin-induced damage to kidney cells. ConclusionB. aristata extract can be used along with vancomycin treatment to minimize its toxicity.