Intrawound application of vancomycin changes the responsible germ in elective spine surgery without significant effect on the rate of infection: a randomized prospective study
Surgical site infection (SSI) is a costly complication associated with spine surgery. The impact of intrawound vancomycin has not been strongly postulated to decrease the risk of surgical site infection. We designed study to determine whether intrawound vancomycin application reduces the risk of SSI in patients after spine surgery.
A prospective randomized control trial study to evaluate the patients with elective spine surgery in a period of 15 month was designed. Patients were divided into two groups based on whether intrawound vancomycin was applied or not. The relative risk of SSI within postoperative 30 days was evaluated.
Three hundred and eighty patients were included in this study: degenerative spine pathologies and tumor 80% (304), trauma 11% (42) and deformity 9% (34). Intrawound vancomycin was used in 51% of patients. Prevalence of SSI was 2.7% in the absence of vancomycin use versus 5.2% with intrawound vancomycin. In multivariable regression model, those with higher number of levels exposed, postoperative ICU admission and obesity and use of instrumentation more than two levels had higher risk of developing SSI. In the treatment group Acinetobacter and Pseudomonas aeruginosa (20%) were the most common pathogens. In control group, Staphylococcus aureus and Acinetobacter (40%) were the most common organisms.
Intrawound application of vancomycin after elective spine surgery was not associated with reduced risk of SSI and return to OR associated with SSI in our patients. However, the use of intrawound vancomycin changed the responsible infection germ.
KeywordsSpine infection Intrawound vancomycin Elective spine surgery
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 5.Poelstra K, Vaccaro A, Albert T (2007) Gentamicin microspheres for infection prophylaxis in the rabbit spine. In: 53rd Orthopaedic Research Society (ORS) meeting, San Diego, CA, p 10–14Google Scholar
- 6.Dennis H et al (2016) Is intraoperative local vancomycin powder the answer to surgical site infections in spine surgery? Spine 42:267–274Google Scholar
- 11.Godil SS et al (2013) Comparative effectiveness and cost-benefit analysis of local application of vancomycin powder in posterior spinal fusion for spine trauma: clinical article. J Neurosurg: Spine 19(3):331–335Google Scholar
- 19.Centers for Medicare and Medicaid Services (2007) Medicare program; changes to the hospital inpatient prospective payment systems and fiscal year 2008 rates. Fed Regist 72(162):47129Google Scholar
- 26.Khan NR et al (2014) A meta-analysis of spinal surgical site infection and vancomycin powder: a review. J Neurosurg: Spine 21(6):974–983Google Scholar
- 38.Molinari WJ, Khera O, Molinari RW (2011) Prophylactic operative site powdered vancomycin and postoperative deep spinal wound infection: 1,512 consecutive surgical cases during a six-year period: PAPER# 37. In: Spine journal meeting abstracts, LWWGoogle Scholar
- 39.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 38(25):2149–2155CrossRefPubMedGoogle Scholar
- 40.Martin JR et al (2015) Experience with intrawound vancomycin powder for posterior cervical fusion surgery. J Neurosurg: Spine 22(1):26–33Google Scholar