Does Vancomycin Powder Decrease Surgical Site Infections in Growing Spine Surgery?

Thompson, George H.; Poe-Kochert, Connie; Hardesty, Christina K.; Son-Hing, Jochen P.; Mistovich, R. Justin

doi:10.2106/jbjs.17.00459

Cited by 45 publications

(32 citation statements)

References 16 publications

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“…In spinal surgery, the reduction in the rate of infection through locally applied vancomycin was established more than 10 years ago and has been well documented by meta-analyses and animal experiments 5 – 8 . The positive effect is set against minor complications caused in 0.3% of cases, mostly culture-negative seroma formation 9 , so that it is even used successfully in children 10 .…”

Section: Introductionmentioning

confidence: 99%

Intraarticular vancomycin powder is effective in preventing infections following total hip and knee arthroplasty

Matziolis

Brodt

Böhle

et al. 2020

Sci Rep

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Locally applied vancomycin is increasingly being used in primary hip and knee arthroplasty to reduce the risk of infection. Despite encouraging initial results, considerable debate remains on the basis of the data currently available. In particular, it has been unclear up to now whether local vancomycin is suitable to further reduce the risk of infection even if the rate of infection is already low (< 1%). In this monocentric retrospective cohort study, all primary total hip and knee arthroplasties performed between 2013 and 2018 were included. After a change in procedure at the hospital, 1 g vancomycin powder was applied intraarticularly before wound closure. The remaining perioperative procedure was constant over the investigation period. The follow-up was one year. The presence of an infection according to the currently valid MSIS criteria was defined as the endpoint. In patients with TKA two infections (0.3%) were observed under vancomycin prophylaxis in contrast to 44 infections (1.3%) in the control group (p = 0.033). In patients with THA two infections (0.5%) were observed under vancomycin prophylaxis and 48 infections (1.1%) in the control group without local vancomycin but this difference was statistically not significant. No wound complications requiring revision were observed as a result of the vancomycin. On the basis of the results of this study, intraarticular application of vancomycin powder in total hip and knee arthroplasty may be considered. Prospective randomized studies have to confirm this promising results prior a common recommendation. Level of Evidence III Retrospective cohort study. Infections after endoprosthetic hip or knee replacement, in spite of all perioperative improvements, are observed with an incidence of 1-2% 1-4. Despite the apparently low risk, efforts to further reduce the risk are sensible in light of the consequences for the patients concerned, with the potential for several follow-up operations and the often limited functional outcome. In spinal surgery, the reduction in the rate of infection through locally applied vancomycin was established more than 10 years ago and has been well documented by meta-analyses and animal experiments 5-8. The positive effect is set against minor complications caused in 0.3% of cases, mostly culture-negative seroma formation 9, so that it is even used successfully in children 10. Otte et al. were able to show that intrawound vancomycin powder lowers the infection rate after knee and hip arthroplasty from 1.6 to 0.5%, compared with a control group 11. In a subgroup analysis, the effect in revision operations was even greater, with a reduction of the infection rate from 3.9 to 0%. Patel et al. showed a reduction in the infection rate through vancomycin of 2.7-0.3% and determined a number needed to treat (NNT) of 47.5 12. Systemic side effects were not observed. The local application of vancomycin was assessed to be safe and cost-effective. Dial et al. observed a similar effect in primary hip arthroplasty, with a lowering of the infection rate...

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Section: Introductionmentioning

confidence: 99%

Intraarticular vancomycin powder is effective in preventing infections following total hip and knee arthroplasty

Matziolis

Brodt

Böhle

et al. 2020

Sci Rep

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“…We have attributed this to the use of the vancomycin wash. We acknowledge that Ghobrial and colleagues failed to demonstrate a reduction in infections following intrathecal baclofen procedures with the use of vancomycin powder (18). However, more recently, Thompson and colleagues and Tailaiti and colleagues have demonstrated a reduction in surgical site infections with the use of vancomycin powder (19,20). In the case of the ITB pump replacements, it is possible that the turbulence generated with a "washout" as in our method, is more effective than instilling vancomycin powder.…”

Section: Discussionmentioning

confidence: 82%

Reducing Intrathecal Baclofen Related Infections: Service Evaluation and Best Practice Guidelines

Balaratnam

Donnelly

Padilla

et al. 2020

Neuromodulation: Technology at the Neural Interface

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Objectives: Intrathecal baclofen (ITB) pumps are an effective treatment for spasticity; however infection rates have been reported in 3-26% of patients in the literature. The multidisciplinary ITB service has been established at The National Hospital for Neurology and Neurosurgery, UCLH, Queen Square, London for over 20 years. Our study was designed to clarify the rate of infection in our ITB patient cohort and secondly, to formulate and implement best practice guidelines and to determine prospectively, whether they effectively reduced infection rates.

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“…In total, 992 studies were screened by title, and 31 studies 8 – 38 were included in the final meta-analysis. The 31 studies included a total of 17,708 patients.…”

Section: Resultsmentioning

confidence: 99%

“…This could be explained by the already significantly lower ratio of SSI after spinal surgeries with no internal fixation. As presented in Table 1 , patients in different studies underwent different surgical procedures ranging from more invasive thoracolumbar deformity correction and tumor removal 12 , 25 , 26 , 33 , 34 to less invasive decompression and fracture stabilization. 8 , 27 – 30 For example, the incidence of SSI was as high as 5.2% among patients undergoing deformity correction in the study by Martin et al., 25 versus less than 1% among patients undergoing posterior cervical spine surgeries.…”

Section: Discussionmentioning

confidence: 99%

A meta-analysis of the local application of vancomycin powder to prevent surgical site infection after spinal surgeries

Shan

et al. 2020

J Int Med Res

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Objective This study aimed to systematically analyze the effectiveness and safety of the local application of vancomycin powder to prevent surgical site infection (SSI) after spinal surgeries and provide guidance for clinical practice. Methods Two researchers independently searched PubMed, Web of Science, Elsevier, and China National Knowledge Infrastructure using the MeSH terms “spinal surgery,” “vancomycin,” “local,” “topical,” “prophylactic,” “surgical site infection,” and “SSI” to identify studies published between January 2010 and January 2020 on the local application of vancomycin powder for preventing SSI after spinal surgeries. The outcome assessment indicators were analyzed using RevMan 5.3 software. Results Three randomized controlled trials, two prospective studies, and 26 retrospective studies were included in the current research. The results of the meta-analysis revealed significant differences between the vancomycin and control groups (non-vancomycin group) concerning the incidence of SSI (risk ratio = 0.39, 95% confidence interval = 0.28–0.55, Z = 5.46), indicating that local application of vancomycin powder can significantly reduce the incidence of SSI. Conclusion Local application of vancomycin powder is an effective and safe method to prevent SSI after spinal surgeries.

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Does Vancomycin Powder Decrease Surgical Site Infections in Growing Spine Surgery?

Abstract: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cited by 45 publications

References 16 publications

Intraarticular vancomycin powder is effective in preventing infections following total hip and knee arthroplasty

Intraarticular vancomycin powder is effective in preventing infections following total hip and knee arthroplasty

Reducing Intrathecal Baclofen Related Infections: Service Evaluation and Best Practice Guidelines

A meta-analysis of the local application of vancomycin powder to prevent surgical site infection after spinal surgeries

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