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

Abstract

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.

Effect of powdered vancomycin on stopping surgical site wound infections in neurosurgery: A meta‐analysis

“…A total of 2367 relevant studies were screened, of which 42 studies between 2011 and 2022, met the inclusion criteria and were involved in the meta‐analysis. 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 Data obtained from these studies were shown in Table 2 . The selected studies included 24 137 subjects with neurosurgery at the baseline of the studies; 10 496 of them were using the powdered vancomycin, and 13 641 were not using the powdered vancomycin as a control.…”

“…The current meta‐analysis involved 24 137 subjects with neurosurgery at the baseline of the studies; 10 496 of them were using the powdered vancomycin, and 13 641 were not using the powdered vancomycin as a control. 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 The powdered vancomycin had significantly lower surgical site wound infections after spinal surgery, deep surgical site wound infections after spinal surgery, superficial surgical site wound infections after spinal surgery, and surgical site wound infections after cranial surgery compared to control in subjects with neurosurgery. The analysis of outcomes should be done with caution even though the low number of studies with a low sample size, 3 out of the 42 studies, in the meta‐analysis, and a low number of studies in certain comparisons.…”

Efficacy and safety of intrawound vancomycin in primary hip and knee arthroplasty

“… 35 Intrawound vancomycin used in spine surgery significantly decreases risk of postoperative infection. 36 This finding likely inspired local vancomycin use in primary hip and knee arthroplasty. 37 Indeed, a previous systematic review and meta-analysis demonstrated that intrawound vancomycin may decrease the risk of PJI in primary (OR 0.44, 95% CI 0.24 to 0.77) and revision (OR 0.28, 95% CI 0.13 to 0.61) TKA and THA; however, that study did not evaluate its safety.…”

Eficacia de la vancomicina, reflejo en costos para la atención del tratamiento de infección en cirugía de columna

“…Estos hallazgos son comparables con otras cohortes que han establecido a la vancomicina en la herida como eficaz para prevenir la ISQ. [6][7][8][9][10][11][12][13][14][15] En 2011 Sweet y colaboradores realizaron un estudio retrospectivo para evaluar la seguridad y eficacia de la aplicación local de VP como complemento para la profilaxis de ISQ de la columna torácica y lumbar instrumentadas por Paciente con infección profunda del sitio de herida quirúrgica, perteneciente al grupo sin uso de vancomicina tópica; posterior a la complicación, se empleó el sistema de presión negativa para lograr el cierre completo de la herida.…”

“…[1][2][3][4][5] El bajo costo, la disponibilidad y fácil aplicación de la vancomicina en los centros de referencia nacional para cirugía de columna brinda la oportunidad de ofrecer una alternativa eficaz y segura en la prevención contra agentes infecciosos, S. epidermidis y S. aureus, que resultan sensibles a la acción de la vancomicina en polvo (VP). [6][7][8][9][10][11][12][13][14][15] Cohortes en Norteamérica describen el costo de la VP en 12 dólares y revelan costos por atención individual a un paciente por cirugía de columna en alrededor de 92,884 dólares, se determinó que la infección incrementa el costo en un rango de 14,459 a 114,763 dólares. A nivel mundial se estima que los costos para tratar una infección de sitio quirúrgico (ISQ) va desde el tratamiento antimicrobiano oral para un caso superficial alrededor de los 400 dólares hasta cifras mayores a los 30,000 dólares que toman en cuenta la hospitalización y cirugías de revisión en infecciones profundas.…”