Meta-analysis of topical vancomycin powder for microbial profile in spinal surgical site infections
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.
KeywordsVancomycin 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.
- 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):556–563Google Scholar
- 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):2084–2088Google Scholar
- 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):550–555Google Scholar
- 10.Wells GA SB ODPJ, Welch V LM The Newcastle-Ottawa Scale (NOS) for assessing the quality if nonrandomized studies in meta-analyses. https://www.ohri.ca/programs/clinical_epidemiology/oxford.htm [cited 2018 Oct 11]
- 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):991–994Google Scholar
- 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):2205–2212Google Scholar
- 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):35–39Google Scholar
- 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):267–274Google Scholar
- 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):545–550Google Scholar
- 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):177–184Google Scholar
- 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):1875–1880Google Scholar
- 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):1183–1187Google Scholar
- 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):2149–2155Google Scholar