Prophylactic use of intraoperative vancomycin powder and postoperative infection: an analysis of microbiological patterns in 1200 consecutive surgical cases

Adogwa, Owoicho; Elsamadicy, Aladine A.; Sergesketter, Amanda R.; Vuong, Victoria D.; Mehta, Ankit I.; Vasquez, Raul A.; Cheng, Joseph; Bagley, Carlos A.; Karikari, Isaac O.

doi:10.3171/2017.2.spine161310

Cited by 53 publications

(40 citation statements)

References 44 publications

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“…However, the study demonstrated that over half of the patients treated with vancomycin powder who developed SSI were positive for gram-negative pathogens. 2 In a study of 5909 cases of posterior thoracic or lumbar surgeries, Grabel et al found 115 cases of SSI. 12 After a review of the 115 cases of SSI, they found that 42 patients received vancomycin powder while 73 did not.…”

Section: Ssi Secondary To Gram-negative Pathogenmentioning

confidence: 99%

The effect of prophylactic vancomycin powder on infections following spinal surgeries: a systematic review

Dodson¹,

Majmundar²,

Swantic³

et al. 2019

Neurosurgical Focus

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OBJECTIVEThe use of vancomycin powder in spine surgery for prophylaxis against surgical site infections (SSIs) is well debated in the literature, with the majority of studies demonstrating improvement and some studies demonstrating no significant reduction in infection rate. It is well known in certain populations that vancomycin powder reduces the general rate of infection, but its effects on reducing the rate of infection due to gram-negative pathogens are not well reviewed. The goal of this paper was to review studies that investigated the efficacy of vancomycin powder as a prophylactic agent against SSI and demonstrate whether the rate of infections by gram-negative pathogens is impacted.METHODSAn electronic search of the published literature was performed using PubMed and Google Scholar in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A variety of combinations of the search terms “vancomycin powder,” “infection,” “spine,” “gram-negative,” “prophylaxis,” and “surgical site” was used. Inclusion criteria were studies that 1) described an experimental group that received intraoperative intrawound vancomycin powder; 2) included adequately controlled groups that did not receive intraoperative intrawound vancomycin powder; 3) included the number of patients in both the experimental and control groups who developed infection after their spine surgery; and 4) identified the pathogen-causing infection. Studies not directly related to this review’s investigation were excluded from the initial screen. Among the studies that met the criteria of the initial screen, additional reasons for exclusion from the systematic review included lack of a control group, unspecified size of control groups, and inconsistent use of vancomycin powder in the experimental group.RESULTSThis systematic review includes 21 studies with control groups. Vancomycin powder significantly reduced the relative risk of developing an SSI (RR 0.55, 95% CI 0.45–0.67, p < 0.0001). In addition, the use of vancomycin powder did not significantly increase the risk of infection by gram-negative pathogens (RR 1.11, 95% CI 0.66–1.86, p = 0.701).CONCLUSIONSThe results of this systematic review suggest that intrawound vancomycin powder is protective against SSI. It is less clear if this treatment increases the risk of gram-negative infection. Further studies are required to investigate whether rates of infection due to gram-negative pathogens are affected by the use of vancomycin powder.

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Section: Ssi Secondary To Gram-negative Pathogenmentioning

confidence: 99%

The effect of prophylactic vancomycin powder on infections following spinal surgeries: a systematic review

Dodson¹,

Majmundar²,

Swantic³

et al. 2019

Neurosurgical Focus

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“…2 The rates of infection with different organisms following spine surgery vary by study; however, some of the most frequent organisms identified are grampositive cocci including methicillin-resistant Staphylococcus aureus (MRSA) and Staphylococcus epidermidis. 3 Increasing methicillin resistance has decreased the efficacy of intravenous cephalosporins as the standard preoperative antibiotic prophylaxis used in orthopedic procedures in general, and spine surgery in particular. [3][4][5] Studies have reported that more than 60% of wound infection isolates in the United States are cephalosporin-resistant, including MRSA and coagulase-negative Staphylococcus.…”

Section: Introductionmentioning

confidence: 99%

“…3 Increasing methicillin resistance has decreased the efficacy of intravenous cephalosporins as the standard preoperative antibiotic prophylaxis used in orthopedic procedures in general, and spine surgery in particular. [3][4][5] Studies have reported that more than 60% of wound infection isolates in the United States are cephalosporin-resistant, including MRSA and coagulase-negative Staphylococcus. 6,7 Among orthopedic patients in the United States, 20% to 30% have anterior nares colonized by methicillin-sensitive S aureus (MSSA), and 2% to 6% are colonized by MRSA.…”

Section: Introductionmentioning

confidence: 99%

The Cost-Effectiveness of Vancomycin Powder in Lumbar Laminectomy

Kerbel

Kirchner

Sunkerneni

et al. 2019

Global Spine Journal

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Study Design: Break-even cost analysis. Objective: The goal of this study is to examine the cost-effectiveness of vancomycin powder for preventing infection following lumbar laminectomy. Methods: The product cost of vancomycin powder was obtained from our institution’s purchasing records. Infection rates and revision costs for lumbar laminectomy and lumbar laminectomy with fusion were obtained from the literature. A break-even analysis was then performed to determine the absolute risk reduction (ARR) in infection rate to make prophylactic application of vancomycin powder cost-effective. Analysis of lumbar laminectomy with fusion was performed for comparison. Results: Costing $3.06 per gram at our institution, vancomycin powder was determined to be cost-effective in lumbar laminectomy if the infection rate of 4.2% decreased by an ARR of 0.015%. Laminectomy with fusion was also determined to be cost-effective at the same cost of vancomycin powder if the infection rate of 8.5% decreased by an ARR of 0.0034%. The current highest cost reported in the literature, $44.00 per gram of vancomycin powder, remained cost-effective with ARRs of 0.21% and 0.048% for laminectomy and laminectomy with fusion, respectively. Varying the baseline infection rate did not influence the ARR for either procedure when the analysis was performed using the product cost of vancomycin at our institution. Conclusions: This break-even analysis demonstrates that prophylactic vancomycin powder can be highly cost-effective for lumbar laminectomy. At our institution, vancomycin powder is economically justified if it prevents at least one infection out of 6700 lumbar laminectomy surgeries.

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“…Staphylococcus aureus is a leading cause of infection-related morbidity and mortality [1][2][3][4] and the most common cause of postoperative infection. [5][6][7] Erythromycin, penicillin, gentamicin, and vancomycin are typically used for the treatment of S. aureus infection. However, due to the abuse of antibiotics, new multidrug-resistant strains have emerged, thus hindering the management of S. aureus.…”

Section: Introductionmentioning

confidence: 99%

Safety of Staphylococcus aureus four-antigen and three-antigen vaccines in healthy adults: A meta-analysis of randomized controlled trials

Zhu

2017

Human Vaccines & Immunotherapeutics

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Prophylactic use of intraoperative vancomycin powder and postoperative infection: an analysis of microbiological patterns in 1200 consecutive surgical cases

Cited by 53 publications

References 44 publications

The effect of prophylactic vancomycin powder on infections following spinal surgeries: a systematic review

The effect of prophylactic vancomycin powder on infections following spinal surgeries: a systematic review

The Cost-Effectiveness of Vancomycin Powder in Lumbar Laminectomy

Safety of Staphylococcus aureus four-antigen and three-antigen vaccines in healthy adults: A meta-analysis of randomized controlled trials

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