Skip to main content

Advertisement

SpringerLink
Log in

Prophylactic intraoperative powdered vancomycin and postoperative deep spinal wound infection: 1,512 consecutive surgical cases over a 6-year period

  • Case Report
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study is to evaluate the effect of intraoperative powdered vancomycin on the rates of postoperative deep spinal wound infection. The use of intraoperative powdered vancomycin as a prophylactic measure in an attempt to reduce the incidence of postoperative spinal wound infection has not been sufficiently evaluated in the existing literature. A retrospective review of a large clinical database was performed to determine the rates of deep wound infection associated with the use of intraoperative operative site powdered vancomycin.

Materials and methods

During the period from 2005 to 2010, 1,512 consecutive spinal surgery cases were performed by the same fellowship-trained spinal surgeon (RWM) at a level 1 trauma-university medical center. One gram of powdered vancomycin was placed in all surgical sites prior to wound closure. Eight hundred forty-nine cases were uninstrumented, 478 cases were instrumented posterior thoracic or lumbar, 12 were instrumented anterior thoracic or lumbar, 126 were instrumented anterior cervical, and 47 were instrumented posterior cervical cases. Fifty-eight cases were combined anterior and posterior surgery and 87 were revision surgeries. A retrospective operative database and medical record review was performed to evaluate for evidence of postoperative deep wound infection.

Results

15 of the 1,512 patients (0.99%) were identified as having evidence of postoperative deep wound infection. At least one pre-existing risk factor for deep infection was present in 8/15 pts (54%). Staphylococcus aureus and methicillin-resistant S. aureus (MRSA) were the most commonly identified organisms (11/15 cases). The rate of deep wound infection was 1.20% (8/663) for instrumented spinal surgeries, and 0.82% (7/849) for uninstrumented surgeries. Deep infection occurred in only 1.23% (4/324) of multilevel instrumented posterior spinal fusions, 1.37% (1/73) of open PLIF procedures, and 1.23% (1/81) of single-level instrumented posterior fusions. Deep infection was not observed in any patient who had uninstrumented spinal fusion (0/64). The deep infection rate for revision surgeries was 1.15% (1/87) and 0.55% (1/183) for trauma surgery. Increased rates of complications related to powdered vancomycin use were not identified in this series. Conclusion

In this series of 1,512 consecutive spinal surgeries, the use of 1 g of powdered intraoperative vancomycin placed in the wound prior to wound closure appears to associated with a low rate deep spinal wound infection for both instrumented and uninstrumented cases. Rates of deep infection for instrumented fusion surgery, trauma, and revision surgery appear to be among the lowest reported in the existing literature. Further investigation of this prophylactic adjunctive measure is warranted.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

References

  1. Calderone RR, Garland DE, Capen DA, Oster H (1996) Cost of medical care for postoperative spinal infections. Orthop Clin North Am 27:171–182

    PubMed  CAS  Google Scholar 

  2. Banco SP, Vaccaro AR, Blam O, Eck JC, Cotler JM, Hilibrand AS, Albert TJ, Murphey S (2002) Spine infections: variations in incidence during the academic year. Spine (Phila Pa 1976) 27:962–965

    Article  Google Scholar 

  3. Blam OG, Vaccaro AR, Vanichkachorn JS, Albert TJ, Hilibrand AS, Minnich JM, Murphey SA (2003) Risk factors for surgical site infection in the patient with spinal injury. Spine (Phila Pa 1976) 28:1475–1480. doi:10.1097/01.BRS.0000067109.23914.0A

    Google Scholar 

  4. Olsen MA, Mayfield J, Lauryssen C, Polish LB, Jones M, Vest J, Fraser VJ (2003) Risk factors for surgical site infection in spinal surgery. J Neurosurg 98:149–155

    PubMed  Google Scholar 

  5. Wimmer C, Gluch H, Franzreb M, Ogon M (1998) Predisposing factors for infection in spine surgery: a survey of 850 spinal procedures. J Spinal Disord 11:124–128

    PubMed  CAS  Google Scholar 

  6. Smith JS, Shaffrey CI, Sansur CA, Berven SH, Fu KM, Broadstone PA, Choma TJ, Goytan MJ, Noordeen HH, Knapp DR, Hart RA, Donaldson WF 3rd, Polly DW Jr, Perra JH, Boachie-Adjei O (2010) Rates of infection following spine surgery based on 108, 419 procedures: a REPORT from the Scoliosis Research Society Morbidity and Mortality Committee. Spine (Phila Pa 1976) 35:2140–2149. doi:10.1097/BRS.0b013e3181eadd41

    Article  Google Scholar 

  7. Pull ter Gunne AF, Cohen DB (2009) Incidence, prevalence, and analysis of risk factors for surgical site infection following adult spinal surgery. Spine (Phila Pa 1976) 34:1422–1428. doi:10.1097/BRS.0b013e3181a03013

    Article  Google Scholar 

  8. Fang A, Hu SS, Endres N, Bradford DS (2005) Risk factors for infection after spinal surgery. Spine (Phila Pa 1976) 30:1460–1465. doi:10.1097/00007632-200506150-00021

    Article  Google Scholar 

  9. Ho C, Sucato DJ, Richards BS (2007) Risk factors for the development of delayed infections following posterior spinal fusion and instrumentation in adolescent idiopathic scoliosis patients. Spine (Phila Pa 1976) 32:2272–2277. doi:10.1097/BRS.0b013e31814b1c0b

    Article  Google Scholar 

  10. Klekamp J, Spengler DM, McNamara MJ, Haas DW (1999) Risk factors associated with methicillin-resistant staphylococcal wound infection after spinal surgery. J Spinal Disord 12:187–191

    PubMed  CAS  Google Scholar 

  11. Mastronardi L, Tatta C (2004) Intraoperative antibiotic prophylaxis in clean spinal surgery: a retrospective analysis in a consecutive series of 973 cases. Surg Neurol 61:129–135. pii:S0090301903006566 (discussion 135)

    Google Scholar 

  12. Cheng MT, Chang MC, Wang ST, Yu WK, Liu CL, Chen TH (2005) Efficacy of dilute betadine solution irrigation in the prevention of postoperative infection of spinal surgery. Spine (Phila Pa 1976) 30:1689–1693. pii:00007632-200508010-00002

    Google Scholar 

  13. Chang FY, Chang MC, Wang ST, Yu WK, Liu CL, Chen TH (2006) Can povidone–iodine solution be used safely in a spinal surgery? Eur Spine J 15:1005–1014. doi:10.1007/s00586-005-0975-6

    Article  PubMed  Google Scholar 

  14. Brown MD, Brookfield KF (2004) A randomized study of closed wound suction drainage for extensive lumbar spine surgery. Spine (Phila Pa 1976) 29:1066–1068. doi:10.1097/00007632-200405150-00003

    Article  Google Scholar 

  15. Celik SE, Kara A (2007) Does shaving the incision site increase the infection rate after spinal surgery? Spine (Phila Pa 1976) 32:1575–1577. doi:10.1097/BRS.0b013e318074c39f

    Article  Google Scholar 

  16. Epstein NE (2007) Do silver-impregnated dressings limit infections after lumbar laminectomy with instrumented fusion? Surg Neurol 68:483–485. doi:10.1016/j.surneu.2007.05.045 (discussion 485)

    Google Scholar 

  17. Lonstein J, Winter R, Moe J, Gaines D (1973) Wound infection with Harrington instrumentation and spine fusion for scoliosis. Clin Orthop Relat Res 96:222–233

    Google Scholar 

  18. Massie JB, Heller JG, Abitbol JJ, McPherson D, Garfin SR (1992) Postoperative posterior spinal wound infections. Clin Orthop Relat Res 284:99–108

    Google Scholar 

  19. Payne DH, Fischgrund JS, Herkowitz HN, Barry RL, Kurz LT, Montgomery DM (1996) Efficacy of closed wound suction drainage after single-level lumbar laminectomy. J Spinal Disord 9:401–403

    Article  PubMed  CAS  Google Scholar 

  20. Omeis IA, Dhir M, Sciubba DM, Gottfried ON, McGirt MJ, Attenello FJ, Wolinsky JP, Gokaslan ZL (2011) Postoperative surgical site infections in patients undergoing spinal tumor surgery: incidence and risk factors. Spine (Phila Pa 1976) 36:1410–1419. doi:10.1097/BRS.0b013e3181f48fa9

    Article  Google Scholar 

  21. Rechtine GR, Bono PL, Cahill D, Bolesta MJ, Chrin AM (2001) Postoperative wound infection after instrumentation of thoracic and lumbar fractures. J Orthop Trauma 15:566–569

    Article  PubMed  CAS  Google Scholar 

  22. Collins I, Wilson-MacDonald J, Chami G, Burgoyne W, Vineyakam P, Berendt T, Fairbank J (2008) The diagnosis and management of infection following instrumented spinal fusion. Eur Spine J 17:445–450. doi:10.1007/s00586-007-0559-8

    Article  PubMed  Google Scholar 

  23. Schimmel JJ, Horsting PP, de Kleuver M, Wonders G, van Limbeek J (2010) Risk factors for deep surgical site infections after spinal fusion. Eur Spine J 19:1711–1719. doi:10.1007/s00586-010-1421-y

    Article  PubMed  CAS  Google Scholar 

  24. Capen DA, Calderone RR, Green A (1996) Perioperative risk factors for wound infections after lower back fusions. Orthop Clin North Am 27:83–86

    PubMed  CAS  Google Scholar 

  25. Haines SJ (1982) Topical antibiotic prophylaxis in neurosurgery. Neurosurgery 11:250–253

    Article  PubMed  CAS  Google Scholar 

  26. Maguire WB (1964) The use of antibiotics, locally and systemically, in orthopedic surgery. Med J Aust 2:412–414

    PubMed  CAS  Google Scholar 

  27. Nachmie B, Siffert RS (1968) A study of neomycin instillation into orthopaedic wounds. JAMA 204:687–689

    Article  Google Scholar 

  28. Schuster JM, Rechtine G, Norvell DC, Dettori JR (2010) The influence of perioperative risk factors and therapeutic interventions on infection rates after spine surgery: a systematic review. Spine(Phila Pa 1976) 35:S125–S137. doi:10.1097/BRS.0b013e3181d8342c

    Article  Google Scholar 

  29. Schmidmaier G, Lucke M, Wildemann B, Haas NP, Raschke M (2006) Prophylaxis and treatment of implant-related infections by antibiotic-coated implants: a review. Injury 37(Suppl 2):S105–S112. doi:10.1016/j.injury.2006.04.016

    Article  PubMed  Google Scholar 

  30. Brown EM, Pople IK, de Louvois J, Hedges A, Bayston R, Eisenstein SM, Lees P (2004) Spine update: prevention of postoperative infection in patients undergoing spinal surgery. Spine (Phila Pa 1976) 29:938–945. doi:10.1097/00007632-200404150-00023

    Article  Google Scholar 

Download references

Acknowledgments

The authors wish to thank Kimberly A. Napoli for assistance preparing this manuscript.

Conflict of interest

None of the authors has any potential conflict of interest.

Author information

Authors and Affiliations

  1. Department of Orthopaedics and Rehabilitation, University of Rochester, 601 Elmwood Ave, Box 665, Rochester, NY, 14642, USA

    Robert W. Molinari, Oner A. Khera & William J. Molinari III

Authors
  1. Robert W. Molinari
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Oner A. Khera
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. William J. Molinari III
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Robert W. Molinari.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Molinari, R.W., Khera, O.A. & Molinari III, W.J. Prophylactic intraoperative powdered vancomycin and postoperative deep spinal wound infection: 1,512 consecutive surgical cases over a 6-year period. Eur Spine J 21 (Suppl 4), 476–482 (2012). https://doi.org/10.1007/s00586-011-2104-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-011-2104-z

Keywords

Search

Navigation