A meta-analysis of spinal surgical site infection and vancomycin powder

Khan, Nickalus R.; Thompson, C.; DeCuypere, Michael; Angotti, Jonathan; Kalobwe, Erick; Muhlbauer, Michael S.; Camillo, Francis X.; Klimo, Paul

doi:10.3171/2014.8.spine1445

Cited by 140 publications

(109 citation statements)

References 51 publications

(62 reference statements)

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“…However, we could not find a connection between high postoperative ESR levels and the presence of a SSI. In concordance of our study, it was reported in the literature that CRP was more sensitive and specific than ESR when evaluating the response to the treatment of infection (27)(28)(29).…”

Section: Biochemical and Microbiological Investigationssupporting

confidence: 92%

Which Risk Factors are Important in Spinal Infection?

Eren¹,

Güzey²,

Kitiş

et al. 2017

Shafa Ortho J

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Background: Infection is the most common complication of spinal surgeries. Surgical site infection (SSI) can result in high hospitalisation costs owing to prolonged hospital stays, repeated surgeries and an increase in the frequency of pseudoarthrosis. Objectives: The purpose of this study was to identify the risk factors of SSI in patients treated with thoracolumbar posterior spinal instrumentation. Methods: Inclusion criteria were treated by posterior thoracolumbar stabilization with transpedicular screw and posterolateral fusion in the neurosurgery clinic between March 2006 and June 2009. Overall, 260 consecutive patients were identified and 239 patients included in this study. Risk factors that may cause increase of rate of SSI were evaluated.

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Section: Biochemical and Microbiological Investigationssupporting

confidence: 92%

Which Risk Factors are Important in Spinal Infection?

Eren¹,

Güzey²,

Kitiş

et al. 2017

Shafa Ortho J

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show abstract

“…In the USA and UK, about 50% of bacteria detected in infected patients in intensive care units are MRSA 18,[27][28][29] ; i.e., the AMP protocol currently administered intravenously is effective for only about 50% of hospital infection cases. Thus, intrawound vancomycin has recently been clinically applied and its efficacy has been frequently reported 14,19,[30][31][32] , but the effect has also been questioned in some reports 33,34) .…”

Section: Resultsmentioning

confidence: 99%

“…Godil et al showed that the cost of care for one deep spine infection case is over US$33,000 17) . The cost of a 1 g dose of VCM is US$10-44 14,[17][18][19] , with this cost varying depending on the type of insurance.…”

Section: Medical Costs and Cost Of Vcm For Ssimentioning

confidence: 99%

“…Thus, SSI has occurred at a consistent rate in previous studies, despite various countermeasures being taken [1][2][3][4][5][6][7][8][9][10][11][12][13][14] . Once infection occurs, further surgery and long-term antimicrobial drug administration are necessary to control infection in many cases, resulting in prolongation of hospital stay and an increased cost of medical care [15][16][17][18][19] . Infection may ultimately be remitted, but SSI reduces the degree of satisfaction and functional prognosis of the patient after surgery [20][21][22][23] .…”

Section: Introductionmentioning

confidence: 99%

“…Guidelines in many countries [24][25][26] specify cefazolin (CEZ) for targeting Staphylococcus aureus. However, difficult SSI cases with methicillin-resistant Staphylococcus aureus (MRSA) as a causative agent have recently increased 18,[27][28][29] , and vancomycin (VCM) has been used for AMP, with the aim of reducing MRSA infection.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Use of intrawound vancomycin powder against postoperative infection after spine surgery

Takahashi

Iida

Yokoyama

et al. 2018

Spine Surg Relat Res

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Abstract:Local application of vancomycin has recently become widely used in spine surgery. However, local application is not included in the indication and has not been approved by the US Food and Drug Administration (FDA). Thus, we searched for reports with "intra wound-vancomycin" and "SSI" as keywords in the MEDLINE database, and investigated the efficacy, problems with use, and future prospects based on these reports. Intrawound vancomycin was described as effective in most of the reports, but was found to have no effect or to aggravate the condition in some reports. A toxic effect on osteoblasts due to a high local concentration was described in some reports, whereas local application was found to be safe in other studies. The amount of vancomycin used and the administration method varied among the reports. Overall, the results suggest that intrawound vancomycin is clinically effective, but this has yet to be established in a randomized controlled trial. There is a need to identify cases that should be selected for this treatment and to investigate the dose and optimum concentration of vancomycin for clinical use.

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Early local delivery of vancomycin suppresses ectopic bone formation in a rat model of trauma‐induced heterotopic ossification

Seavey

Wheatley

Pavey

et al. 2017

Journal Orthopaedic Research

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Heterotopic ossification (HO) is a debilitating sequela of high-energy injuries. It frequently requires surgical excision once symptomatic and there is no practical prophylaxis for combat-injured patients. In this study, we examined the effect of local vancomycin powder on HO formation in a small animal model of blast-related, post-traumatic HO. Male Sprague-Dawley rats were subjected to a polytraumatic extremity injury and amputation with or without methicillin-resistant Staphylococcus aureus infection. Animals were randomized to receive a single local application of vancomycin (20 mg/kg) at the time of injury (POD-0, n = 34) or on postoperative day-3 (POD-3, n = 11). Quantitative volumetric measurement of ectopic bone was calculated at 12-weeks post-injury by micro-CT. Bone marrow and muscle tissues were also collected to determine the bacterial burden. Blood for serum cytokine analysis was collected at baseline and post-injury. Vancomycin treatment on POD-0 suppressed HO formation by 86% and prevented bone marrow and soft tissue infections. We concurrently observed a marked reduction histologically in nonviable tissue, chronic inflammatory cell infiltrates, bone infection, fibrous tissue, and areas of bone necrosis within this same cohort. Delayed treatment was significantly less efficacious. Neither treatment had a marked effect on the production of pro-inflammatory cytokines. Our study demonstrates that local vancomycin treatment at the time of injury significantly reduces HO formation in both the presence and absence of infection, with decreased efficacy if not given early. These findings further support the concept that the therapeutic window for prophylaxis is narrow, highlighting the need to develop early treatment strategies for clinical management. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2397-2406, 2017.

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A meta-analysis of spinal surgical site infection and vancomycin powder

Cited by 140 publications

References 51 publications

Which Risk Factors are Important in Spinal Infection?

Which Risk Factors are Important in Spinal Infection?

Use of intrawound vancomycin powder against postoperative infection after spine surgery

Early local delivery of vancomycin suppresses ectopic bone formation in a rat model of trauma‐induced heterotopic ossification

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