Intrasite vancomycin powder for the prevention of surgical site infection in spine surgery: a systematic literature review

Kang, Daniel G.; Holekamp, Terrence F.; Wagner, Scott C.; Lehman, Ronald A.

doi:10.1016/j.spinee.2015.01.030

Cited by 140 publications

(96 citation statements)

References 54 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Currently used antibiotic-loaded cement, beads, and spacers or powder do not confer tunable release of multiple antibiotics (18)(19)(20). This may compromise the treatment efficiency and it increases the likelihood of the development of antibiotic resistance while patients are on therapy (21,22), which has been seen in as high as 50% of patients with PJI treated with gentamicin or tobramycin spacers (43).…”

Section: Discussionmentioning

confidence: 99%

“…Because most biofilm-associated infections are caused by invading bacteria in the perioperative period, local antibiotic therapy has been clinically used, including antibiotic-loaded cement, beads, spacers, or powder in orthopedic surgery (18)(19)(20) and intraoperative lavage or application of antibiotics in CIED implantation (4,14). However, most of these approaches are only designed for single antibiotic release, which increases the likelihood of the development of antibiotic resistance while patients are on therapy (21,22).…”

mentioning

confidence: 99%

See 1 more Smart Citation

Polymeric nanofiber coating with tunable combinatorial antibiotic delivery prevents biofilm-associated infection in vivo

Ashbaugh

Jiang

Zheng

et al. 2016

Proc. Natl. Acad. Sci. U.S.A.

View full text Add to dashboard Cite

Bacterial biofilm formation is a major complication of implantable medical devices that results in therapeutically challenging chronic infections, especially in cases involving antibiotic-resistant bacteria.As an approach to prevent these infections, an electrospun composite coating comprised of poly(lactic-coglycolic acid) (PLGA) nanofibers embedded in a poly(e-caprolactone) (PCL) film was developed to locally codeliver combinatorial antibiotics from the implant surface. The release of each antibiotic could be adjusted by loading each drug into the different polymers or by varying PLGA:PCL polymer ratios. In a mouse model of biofilm-associated orthopedic-implant infection, three different combinations of antibiotic-loaded coatings were highly effective in preventing infection of the bone/joint tissue and implant biofilm formation and were biocompatible with enhanced osseointegration. This nanofiber composite-coating technology could be used to tailor the delivery of combinatorial antimicrobial agents from various metallic implantable devices or prostheses to effectively decrease biofilm-associated infections in patients.nanofiber | biofilm | infection | antibiotic | delivery

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Polymeric nanofiber coating with tunable combinatorial antibiotic delivery prevents biofilm-associated infection in vivo

Ashbaugh

Jiang

Zheng

et al. 2016

Proc. Natl. Acad. Sci. U.S.A.

View full text Add to dashboard Cite

show abstract

“…16,17 Numerous studies have shown that vancomycin powder significantly reduces the incidence of postoperative infection. 5,15 Powder application of vancomycin is an attractive adjunct to systemic intravenous administration because it provides a means of achieving a very high local bactericidal level, with local concentrations up to 1000-fold higher than the mean inhibitory concentration for MRSA and coagulase-negative S. aureus. 7 Applying vancomycin topically avoids potential systemic side effects, but the literature regarding its impact on bone healing and fusion rates is inconclusive.…”

Section: Discussionmentioning

confidence: 99%

“…Clinical studies to date have failed to make a definitive determination regarding the effect of vancomycin on the rate of pseudarthrosis. 5,15,27 This concern is supported by in vitro studies that suggest that vancomycin is toxic to differentiating osteoblasts at high doses. 23 While the ramifications of these findings have not been shown to affect bone formation in a rat femoral defect model, 24 as of yet, the effect of vancomycin powder application on the rates of spinal arthrodesis has not been properly evaluated.…”

mentioning

confidence: 99%

The effect of vancomycin powder on bone healing in a rat spinal rhBMP-2 model

Mendoza¹,

Sonn²,

Kannan³

et al. 2016

SPI

View full text Add to dashboard Cite

OBJECTIVE This study aims to quantify the impact of vancomycin powder application on new bone formation and spine fusion rates in a rat posterolateral arthrodesis model. METHODS Thirty-six female Sprague-Dawley rats underwent a posterolateral lumbar spinal fusion (PLF) at the L-4 and L-5 vertebrae. Fusion was elicited via implantation of an absorbable collagen sponge containing 3 µg rhBMP-2. Rats were divided into 3 groups: no vancomycin (control), standard-dose vancomycin, and high-dose vancomycin, based on what was applied to the fusion bed. Clinical studies typically describe the application of 1 g vancomycin into the surgical wound. Presuming an average individual patient weight of 70 kg, a weight-based equivalent dose of vancomycin powder was applied subfascially in the PLF model constituting a “standard-dose” treatment group (14.3 mg/kg, n = 12). To determine whether there is a critical threshold beyond which vancomycin increases the risk of pseudarthrosis, a 10-fold higher dose was administered to a “high-dose” treatment group (143 mg/kg, n = 12). No vancomycin powder was applied to the surgical site in the control group (n = 12). Fusion was evaluated with plain radiographs at 4 and 8 weeks after surgery. The spines were harvested after the 8-week radiographs were obtained and evaluated using manual palpation, microCT analysis, and histological analysis. RESULTS Radiographs demonstrated equivalent bridging bone formation in all groups. No significant differences in fusion scores were seen in the standard-dose (mean 2.25) or high-dose (2.13) treatment groups relative to untreated control animals (1.78). Similarly, fusion rates did not differ significantly different between vancomycin-treated animals (100% for both groups) and control animals (92%). Quantification of new bone formation via microCT imaging revealed no significant between-groups differences in the volume of newly regenerated bone (control vs standard-dose vancomycin, p = 0.57; control vs high-dose vancomycin, p = 0.53). CONCLUSIONS This is the first in vivo study to specifically address the development of pseudarthrosis after intrawound application of vancomycin during fusion surgery. Our results demonstrate that vancomycin powder does not inhibit fusion rates at a dose that is the weight-percentage equivalent of what is routinely used by surgeons. Moreover, bone formation and fusion rates were not reduced even after administration of a vancomycin dose that is 10-fold higher than that which is typically administered clinically. Our findings suggest that if there is a critical threshold above which vancomycin inhibits bone healing, such a dose is out of the range which might be considered reasonable for clinical use.

show abstract

“…A dose of 1 or 2 g was commonly selected depending on the surgical wound size, but 0.5 and 6 g were used in some reports. The drug was sprayed with avoidance of the bone graft and dura in some reports, but not in others 42) . In most reports the VCM level was not measured in the surgical wound or serum.…”

Section: Future Prospectsmentioning

confidence: 99%

Use of intrawound vancomycin powder against postoperative infection after spine surgery

Takahashi

Iida

Yokoyama

et al. 2018

Spine Surg Relat Res

View full text Add to dashboard Cite

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.

show abstract

Intrasite vancomycin powder for the prevention of surgical site infection in spine surgery: a systematic literature review

Cited by 140 publications

References 54 publications

Polymeric nanofiber coating with tunable combinatorial antibiotic delivery prevents biofilm-associated infection in vivo

Polymeric nanofiber coating with tunable combinatorial antibiotic delivery prevents biofilm-associated infection in vivo

The effect of vancomycin powder on bone healing in a rat spinal rhBMP-2 model

Use of intrawound vancomycin powder against postoperative infection after spine surgery

Contact Info

Product

Resources

About