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.

Graphic abstract

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5


  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):1198–1208

    CAS  Article  Google 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):904–909

    Article  Google 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):142–146

    Article  Google 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):336–347

    Article  Google 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):556–563

    Article  Google 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):2084–2088

    Article  Google 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):328–334

    Article  Google 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):550–555

    Article  Google 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):1–12

    CAS  Article  Google 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):982–993

    Article  Google 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):1387–1392

    Article  Google 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):1766–1769

    Article  Google 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):991–994

    Article  Google Scholar 

  15. 15.

    Levine DP (2006) Vancomycin: a history. Clin Infect Dis 42(Suppl 1):S5–12

    CAS  Article  Google Scholar 

  16. 16.

    Moellering RC Jr (2006) Vancomycin: a 50-year reassessment. Clin Infect Dis 42(Suppl 1):S3–4

    Article  Google 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):285–292

    Article  Google 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):2205–2212

    PubMed  Google 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):35–39

    CAS  PubMed  Google 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):e12010

    Article  Google 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):746–753

    Article  Google 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):267–274

    Article  Google 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):545–550

    PubMed  PubMed Central  Google 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–E1065

    Article  Google 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):19–25

    CAS  Article  Google 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):1029–1033

    Article  Google 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):E584–589

    Article  Google 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):26–33

    Article  Google 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):517–521

    Article  Google 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):749–754

    Article  Google 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):177–184

    Article  Google 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):1875–1880

    Article  Google 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):1183–1187

    Article  Google 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):121–125

    Article  Google 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):2149–2155

    Article  Google 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):641–646

    Article  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Tao Zhu.

Ethics declarations

Conflict of interest

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

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (PPTX 134 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Li, S., Rong, H., Zhang, X. et al. Meta-analysis of topical vancomycin powder for microbial profile in spinal surgical site infections. Eur Spine J 28, 2972–2980 (2019).

Download citation


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