European Spine Journal

, Volume 28, Issue 12, pp 2972–2980 | Cite as

Meta-analysis of topical vancomycin powder for microbial profile in spinal surgical site infections

  • Sipeng Li
  • Hongtao Rong
  • Xueqin Zhang
  • Zhengshan Zhang
  • Chao Wang
  • Rui Tan
  • Yi Wang
  • Ting Zheng
  • Tao ZhuEmail author
Review Article



To systematically evaluate the impact of topical vancomycin powder for microbial profile in spinal surgical site infections.


All available literature regarding the topical use of vancomycin powder to prevent postoperative spinal infections was retrieved from the MEDLINE, EMBASE, and Cochrane databases starting from the creation date and up until September 30, 2018.


A total of 21 studies involving 15,548 patients were reviewed. The combined odds ratio showed that topical use of vancomycin powder was effective for reducing the incidence of gram-positive bacterial infections in spinal surgical sites (OR 0.41, P < 0.00001) without affecting its efficacy in the prevention of polymicrobial infections (OR 0.30, P = 0.03). Additionally, it could significantly reduce the infection rate of methicillin-resistant staphylococcus (OR 0.34, P < 0.0001). However, topical vancomycin powder showed no advantage for preventing gram-negative bacterial infections (OR 0.94, P = 0.75).


Topical administration of vancomycin powder may not increase the rates of gram-negative bacterial or polymicrobial infections in spinal surgical sites. On the contrary, it can significantly reduce the infection rates of gram-positive bacteria, methicillin-resistant staphylococcus (MRS) and microorganism. Of course, the topical vancomycin powder cannot change the rates of gram-negative bacterial infections, which may be related to the antimicrobial spectrum of vancomycin. Due to the limited number of articles included in this study, additional large-scale and high-quality studies are needed to provide more reliable clinical evidence.

Graphic abstract


Vancomycin powder Spinal surgery Surgical site infections Microbial profile Meta-analysis 


Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest or funding sources in the article.

Supplementary material

586_2019_6143_MOESM1_ESM.pptx (134 kb)
Supplementary file1 (PPTX 134 kb)


  1. 1.
    Magill SS, Edwards JR, Bamberg W, Beldavs ZG et al (2014) Multistate point-prevalence survey of health care-associated infections. N Engl J Med 370(13):1198–1208CrossRefGoogle Scholar
  2. 2.
    Rattan R, Parreco J, Zakrison TL, Yeh DD, Lieberman HM, Namias N (2017) Same-hospital re-admission rate is not reliable for measuring post-operative infection-related re-admission. Surg Infect (Larchmt) 18(8):904–909CrossRefGoogle Scholar
  3. 3.
    Watters WC 3rd, Baisden J, Bono CM, Heggeness MH et al (2009) Antibiotic prophylaxis in spine surgery: an evidence-based clinical guideline for the use of prophylactic antibiotics in spine surgery. Spine J 9(2):142–146CrossRefGoogle Scholar
  4. 4.
    Radcliff KE, Neusner AD, Millhouse PW, Harrop JD et al (2015) What is new in the diagnosis and prevention of spine surgical site infections. Spine J 15(2):336–347CrossRefGoogle Scholar
  5. 5.
    Smith JS, Shaffrey CI, Sansur CA, Berven SH, et al. (2011) Rates of infection after spine surgery based on 108,419 procedures: a report from the Scoliosis Research Society Morbidity and Mortality Committee. Spine (Phila Pa 1976) 36(7):556–563CrossRefGoogle Scholar
  6. 6.
    Sweet FA, Roh M, Sliva C (2011) Intrawound application of vancomycin for prophylaxis in instrumented thoracolumbar fusions: efficacy, drug levels, and patient outcomes. Spine (Phila Pa 1976) 36(24):2084–2088CrossRefGoogle Scholar
  7. 7.
    Adogwa O, Elsamadicy AA, Sergesketter A, Vuong VD et al (2017) Prophylactic use of intraoperative vancomycin powder and postoperative infection: an analysis of microbiological patterns in 1200 consecutive surgical cases. J Neurosurg Spine 27(3):328–334CrossRefGoogle Scholar
  8. 8.
    Ghobrial GM, Thakkar V, Andrews E, Lang M, et al. (2014) Intraoperative vancomycin use in spinal surgery: single institution experience and microbial trends. Spine (Phila Pa 1976) 39(7):550–555CrossRefGoogle Scholar
  9. 9.
    Jadad AR, Moore RA, Carroll D, Jenkinson C et al (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary. Control Clin Trials 17(1):1–12CrossRefGoogle Scholar
  10. 10.
    Wells GA SB ODPJ, Welch V LM The Newcastle-Ottawa Scale (NOS) for assessing the quality if nonrandomized studies in meta-analyses. [cited 2018 Oct 11]
  11. 11.
    Hartling L, Milne A, Hamm MP, Vandermeer B et al (2013) Testing the Newcastle Ottawa Scale showed low reliability between individual reviewers. J Clin Epidemiol 66(9):982–993CrossRefGoogle Scholar
  12. 12.
    Shaffer WO, Baisden JL, Fernand R, Matz PG, North American Spine Society (2013) An evidence-based clinical guideline for antibiotic prophylaxis in spine surgery. Spine J 13(10):1387–1392CrossRefGoogle Scholar
  13. 13.
    Strom RG, Pacione D, Kalhorn SP, Frempong-Boadu AK (2013) Lumbar laminectomy and fusion with routine local application of vancomycin powder: decreased infection rate in instrumented and non-instrumented cases. Clin Neurol Neurosurg 115(9):1766–1769CrossRefGoogle Scholar
  14. 14.
    Strom RG, Pacione D, Kalhorn SP, Frempong-Boadu AK (2013) Decreased risk of wound infection after posterior cervical fusion with routine local application of vancomycin powder. Spine (Phila Pa 1976) 38(12):991–994CrossRefGoogle Scholar
  15. 15.
    Levine DP (2006) Vancomycin: a history. Clin Infect Dis 42(Suppl 1):S5–12CrossRefGoogle Scholar
  16. 16.
    Moellering RC Jr (2006) Vancomycin: a 50-year reassessment. Clin Infect Dis 42(Suppl 1):S3–4CrossRefGoogle Scholar
  17. 17.
    Liu C, Bayer A, Cosgrove SE, Daum RS et al (2011) Clinical practice guidelines by the infectious diseases society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children: executive summary. Clin Infect Dis 52(3):285–292CrossRefGoogle Scholar
  18. 18.
    Horii C, Yamazaki T, Oka H, Azuma S et al (2018) Does intrawound vancomycin powder reduce surgical site infection after posterior instrumented spinal surgery? A propensity score-matched analysis Spine J 18(12):2205–2212PubMedGoogle Scholar
  19. 19.
    Mirzashahi B, Chehrassan M, Mortazavi S (2018) Intrawound application of vancomycin changes the responsible germ in elective spine surgery without significant effect on the rate of infection: a randomized prospective study. Musculoskelet Surg 102(1):35–39PubMedGoogle Scholar
  20. 20.
    Sono T, Fujibayashi S, Izeki M, Shimizu Y et al (2018) Decreased rate of surgical site infection after spinal surgery with instrumentation using bundled approach including surveillance and intrawound vancomycin application. Medicine (Baltimore) 97(34):e12010CrossRefGoogle Scholar
  21. 21.
    Chotai S, Wright PW, Hale AT, Jones WA et al (2017) Does intrawound vancomycin application during spine surgery create vancomycin-resistant organism. Neurosurgery 80(5):746–753CrossRefGoogle Scholar
  22. 22.
    Hey HW, Thiam DW, Koh ZS, Thambiah JS, et al. (2017) Is Intraoperative Local Vancomycin Powder the Answer to Surgical Site Infections in Spine Surgery. Spine (Phila Pa 1976) 42(4):267–274CrossRefGoogle Scholar
  23. 23.
    Hida T, Ando K, Kobayashi K, Ito K et al (2017) Intrawound vancomycin powder as the prophylaxis of surgical site infection after invasive spine surgery with a high risk of infection. Nagoya J Med Sci 79(4):545–550PubMedPubMedCentralGoogle Scholar
  24. 24.
    Van Hal M, Lee J, Laudermilch D, Nwasike C, Kang J (2017) Vancomycin powder regimen for prevention of surgical site infection in complex spine surgeries. Clin Spine Surg 30(8):E1062–E1065CrossRefGoogle Scholar
  25. 25.
    Gaviola ML, McMillian WD, Ames SE, Endicott JA, Alston WK (2016) A retrospective study on the protective effects of topical vancomycin in patients undergoing multilevel spinal fusion. Pharmacotherapy 36(1):19–25CrossRefGoogle Scholar
  26. 26.
    Schroeder JE, Girardi FP, Sandhu H, Weinstein J, Cammisa FP, Sama A (2016) The use of local vancomycin powder in degenerative spine surgery. Eur Spine J 25(4):1029–1033CrossRefGoogle Scholar
  27. 27.
    Heller A, McIff TE, Lai SM, Burton DC (2015) Intrawound vancomycin powder decreases staphylococcal surgical site infections after posterior instrumented spinal arthrodesis. J Spinal Disord Tech 28(10):E584–589CrossRefGoogle Scholar
  28. 28.
    Martin JR, Adogwa O, Brown CR, Kuchibhatla M et al (2015) Experience with intrawound vancomycin powder for posterior cervical fusion surgery. J Neurosurg Spine 22(1):26–33CrossRefGoogle Scholar
  29. 29.
    Suh BK, Moon SH, Kim TH, Oh JK et al (2015) Efficacy of antibiotics sprayed into surgical site for prevention of the contamination in the spinal surgery. Asian Spine J 9(4):517–521CrossRefGoogle Scholar
  30. 30.
    Hill BW, Emohare O, Song B, Davis R, Kang MM (2014) The use of vancomycin powder reduces surgical reoperation in posterior instrumented and noninstrumented spinal surgery. Acta Neurochir (Wien) 156(4):749–754CrossRefGoogle Scholar
  31. 31.
    Martin JR, Adogwa O, Brown CR, Bagley CA, et al. (2014) Experience with intrawound vancomycin powder for spinal deformity surgery. Spine (Phila Pa 1976) 39(2):177–184CrossRefGoogle Scholar
  32. 32.
    Theologis AA, Demirkiran G, Callahan M, Pekmezci M, Ames C, Deviren V (2014) Local intrawound vancomycin powder decreases the risk of surgical site infections in complex adult deformity reconstruction: a cost analysis. Spine (Phila Pa 1976) 39(22):1875–1880CrossRefGoogle Scholar
  33. 33.
    Caroom C, Tullar JM, Benton EG Jr, Jones JR, Chaput CD (2013) Intrawound vancomycin powder reduces surgical site infections in posterior cervical fusion. Spine (Phila Pa 1976) 38(14):1183–1187CrossRefGoogle Scholar
  34. 34.
    Kim HS, Lee SG, Kim WK, Park CW, Son S (2013) Prophylactic intrawound application of vancomycin powder in instrumented spinal fusion surgery. Korean J Spine 10(3):121–125CrossRefGoogle Scholar
  35. 35.
    Tubaki VR, Rajasekaran S, Shetty AP (2013) Effects of using intravenous antibiotic only versus local intrawound vancomycin antibiotic powder application in addition to intravenous antibiotics on postoperative infection in spine surgery in 907 patients. Spine (Phila Pa 1976) 38(25):2149–2155CrossRefGoogle Scholar
  36. 36.
    O'Neill KR, Smith JG, Abtahi AM, Archer KR et al (2011) Reduced surgical site infections in patients undergoing posterior spinal stabilization of traumatic injuries using vancomycin powder. Spine J 11(7):641–646CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Sipeng Li
    • 1
  • Hongtao Rong
    • 1
  • Xueqin Zhang
    • 1
  • Zhengshan Zhang
    • 1
  • Chao Wang
    • 1
  • Rui Tan
    • 1
  • Yi Wang
    • 1
  • Ting Zheng
    • 2
  • Tao Zhu
    • 1
    Email author
  1. 1.Department of NeurosurgeryTianjin Medical University General HospitalTianjinChina
  2. 2.Tianjin Medical University General HospitalTianjinChina

Personalised recommendations