The combined administration of vancomycin IV, standard prophylactic antibiotics, and vancomycin powder in spinal instrumentation surgery: does the routine use affect infection rates and bacterial resistance?

Park, Howard Young; Sheppard, William; Smith, Rhonda L.; Xiao, Jiayang; Gatto, Jonathan D; Bowen, Richard E.; Scaduto, Anthony A.; Holly, Langston T.; Lu, Daniel C.; McBride, Duncan Q.; Shamie, Arya Nick; Park, Don Young

doi:10.21037/jss.2018.05.04

Cited by 17 publications

(10 citation statements)

References 21 publications

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“…Postoperative spinal infections/SSI were typically dependent on the following variables; severity of disease, number of levels involved, presence/duration of postoperative drains used, prior hospitalization, duration of preoperative/postoperative stay, duration of surgery, number of transfusions, and number of surgeons. [1101115313337] In Shillingford et al ., the rate of SSI after scoliosis surgery (Scoliosis Research Society Morbidity/Mortality database) ranged from 1.9% to 4.4%. [37] Out of 47,755 procedures from 2012, 578 (1.2%) had SSIs.…”

Section: Introductionmentioning

confidence: 99%

“…In Park et al ., the incidence of SSI in spine surgery varied from 0.7% to 10%, with higher frequencies for those with significant medical comorbidities. [31] In Pull ter Gunne et al ., 3174 patients (1996–2005) exhibited 132 (4.15%) SSI; 84 were deep, and 48 were superficial. [33] In Epstein's series (2007), the incidence of postoperative SSI following lumbar-instrumented fusions was 0/106 using the Silverlon Dressings for 2 postoperative weeks versus 3 (2.3%) for 128 similar cases previously performed using routine postoperative dressings.…”

Section: Introductionmentioning

confidence: 99%

“…utilized cefazolin IV (standard) in 524 cases (48.8%), gentamicin IV in 526 cases (49.0%), and vancomycin powder in 72.3% cases. [31] Spinal surgery addressed cervical myelopathy (27.9%), lumbar stenosis (16.2%), lumbar spondylolisthesis (14.0%), and scoliosis (13.7%). Four (0.37%) SSI infections occurred in the gentamicin group also using vancomycin powder (3 deep and 1 superficial) versus 11 (1.23%) in the 892 control patients (cefazolin alone).…”

Section: Introductionmentioning

confidence: 99%

“…evaluated the impact of adding vancomycin/gentamicin and/or vancomycin powder (2013–2016) to reduce the risks of MRSA; patients received intravenous cefazolin IV (48.8% of cases), gentamicin IV (49.0% of cases), and/or vancomycin powder (72.3% of cases). [31] Of these, 114 patients required revision spinal procedures (10.6%), and 4 SSIs (0.37%) occurred in the treatment group versus 11 who received cefazolin alone.…”

Section: Introductionmentioning

confidence: 99%

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Preoperative measures to prevent/minimize risk of surgical site infection in spinal surgery

Epstein¹

2018

Surg Neurol Int

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Background: Multiple measures prior to spine surgery may reduce the risks of postoperative surgical site infections (SSIs). Methods: The incidence of SSI following spinal surgery (including reoperations and readmissions) may be markedly reduced by performing less extensive procedures and avoiding fusion where feasible. Preoperative testing up to 3 weeks postoperatively should include other studies to limit the perioperative SSI risk; cardiac stress tests (e.g., older patients/cardiac comorbidities), starting tamsulosin in males over 60 (e.g. avoid urinary retention due to benign prostatic hypertrophy), albumin/prealbumin levels (e.g., low levels increase SSI risk), and HBA1C levels to identify new/treat known diabetics (normalize/reduce preoperative levels). Results: Other measures include the timely administration of preoperative antibiotics (e.g., cefazolin 2 g nonpenicillin allergic), one dose of gentamicin (adjusted dose/weight), nasal cultures for methicillin-resistant Staphylococcus aureus (patients/health-care workers), and bathing 2 weeks preoperatively with chlorhexidine gluconate 4% (not just night before/morning of surgery). Additionally, prior to surgery, the following medications that increase the bleeding risk should be stopped (e.g. for varying periods); anticoagulants, antiplatelet therapies (e.g., aspirin for at least 7–10 days), nonsteroidal anti-inflammatories (NSAIDS: timing depends on the drug), vitamin E, and herbal supplements. Additionally, avoiding elective spinal surgery in morbidly obese patients and recognizing other major medical contraindications to spinal surgery should help reduce infection, morbidity, and mortality rates. Conclusions: Appropriate preoperative and intraoperative prophylactic maneuvers may reduce the risk of postoperative spinal SSI. Specific attention to these details may avoid infections and improve outcomes.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Preoperative measures to prevent/minimize risk of surgical site infection in spinal surgery

Epstein¹

2018

Surg Neurol Int

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“…Vancomycin powder was found to decrease the rate of deep space infections requiring re-operation [166]. Vancomycin powder should be restricted to procedures and patients most at risk of MRSA-related surgical site infection [167][168][169].…”

Section: Intraoperative Period 9 Prevention Of Nausea and Vomiting (mentioning

confidence: 99%

Pathway for enhanced recovery after spinal surgery-a systematic review of evidence for use of individual components

et al. 2021

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Background Enhanced recovery in spinal surgery (ERSS) has shown promising improvements in clinical and economical outcomes. We have proposed an ERSS pathway based on available evidence. We aimed to delineate the clinical efficacy of individual pathway components in ERSS through a systematic narrative review. Methods We included systematic reviews and meta-analysis, randomized controlled trials, non-randomized controlled studies, and observational studies in adults and pediatric patients evaluating any one of the 22 pre-defined components. Our primary outcomes included all-cause mortality, morbidity outcomes (e.g., pulmonary, cardiac, renal, surgical complications), patient-reported outcomes and experiences (e.g., pain, quality of care experience), and health services outcomes (e.g., length of stay and costs). Following databases (1990 onwards) were searched: MEDLINE, EMBASE, and Cochrane Library (Cochrane Database of Systematic Reviews and CENTRAL). Two authors screened the citations, full-text articles, and extracted data. A narrative synthesis was provided. We constructed Evidence Profile (EP) tables for each component of the pathway, where appropriate information was available. Due to clinical and methodological heterogeneity, we did not conduct a meta-analyses. GRADE system was used to classify confidence in cumulative evidence for each component of the pathway. Results We identified 5423 relevant studies excluding duplicates as relating to the 22 pre-defined components of enhanced recovery in spinal surgery. We included 664 studies in the systematic review. We identified specific evidence within the context of spinal surgery for 14/22 proposed components. Evidence was summarized in EP tables where suitable. We performed thematic synthesis without EP for 6/22 elements. We identified appropriate societal guidelines for the remainder of the components. Conclusions We identified the following components with high quality of evidence as per GRADE system: pre-emptive analgesia, peri-operative blood conservation (antifibrinolytic use), surgical site preparation and antibiotic prophylaxis. There was moderate level of evidence for implementation of prehabilitation, minimally invasive surgery, multimodal perioperative analgesia, intravenous lignocaine and ketamine use as well as early mobilization. This review allows for the first formalized evidence-based unified protocol in the field of ERSS. Further studies validating the multimodal ERSS framework are essential to guide the future evolution of care in patients undergoing spinal surgery.

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Topical vancomycin for treatment of methicillin-resistant Staphylococcus epidermidis infection in a rat spinal implant model

et al. 2020

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The combined administration of vancomycin IV, standard prophylactic antibiotics, and vancomycin powder in spinal instrumentation surgery: does the routine use affect infection rates and bacterial resistance?

Cited by 17 publications

References 21 publications

Preoperative measures to prevent/minimize risk of surgical site infection in spinal surgery

Preoperative measures to prevent/minimize risk of surgical site infection in spinal surgery

Pathway for enhanced recovery after spinal surgery-a systematic review of evidence for use of individual components

Topical vancomycin for treatment of methicillin-resistant Staphylococcus epidermidis infection in a rat spinal implant model

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