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Local Application of Vancomycin in Spine Surgery Does Not Result in Increased Vancomycin-Resistant Bacteria—10-Year Data

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Abstract

Study Design

Case-control study.

Objectives

To analyze the microbial flora in surgical spine infections and their antibiotic resistance patterns across time and determine the correlation between vancomycin application in the wound and vancomycin-resistant microbes.

Summary of Background Data

Prior studies show a reduction in surgical site infections with intrawound vancomycin placement. No data are available on the potential negative effects of this intervention, in particular, whether there would be a resultant increase in vancomycin-resistant organisms or bacterial resistance profiles.

Methods

All culture-positive surgical site infections at a single institution were analyzed from 2007 to 2017. Each bacterium was assessed independently for resistance patterns. The two-tailed Fisher exact test was used to determine the correlation between vancomycin application and the presence of vancomycin-resistant bacteria, polymicrobial infections, or gram-negative bacterial infections.

Results

One hundred and eight bacteria were isolated from 113 surgical site infections from 2007 to 2017. The most common organisms were staphylococcus with varying resistance patterns and Escherichia coli. Vancomycin-resistant Enterococcus faecium was isolated in three infections. Out of the 4,878 surgical cases from 2011 to 2017, vancomycin was placed in 48.3%, and no vancomycin in 51.7%. There were 33 infections (1.4%) in the vancomycin group and 20 infections (0.8%) in the no-vancomycin group (χ2 = 0.0521). There was no correlation between vancomycin application in the wound and vancomycin-resistant microbes (χ2 = 0.2334) and polymicrobial infections (χ2 = 0.1328). There was an increased rate of gram-negative organisms in infections after vancomycin application in the wound versus no vancomycin (χ2 = 0.0254).

Conclusions

Topical vancomycin within the surgical site is not correlated with vancomycin-resistant bacteria. However, there was an increased incidence of gram-negative organisms in infections after vancomycin application in the wound versus no vancomycin. Continued surveillance with prospectively collected randomized data is necessary to better understand bacterial evolution against current antimicrobial techniques.

Level of Evidence

Level III.

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of California, San Francisco, 500 Parnassus Ave, MU320W, 94143, San Francisco, CA, USA

    Krishn Khanna MD, Alexander Tenorio BA, Trevor Grace MD, Shane Burch MD, Sigurd Berven MD, Bobby Tay MD & Vedat Deviren MD

  2. California Pacific Orthopaedics, Spine Institute, 3838 California Street, Suite 715, 94118, San Francisco, CA, USA

    Frank Valone III MD

  3. Department of Orthopaedic Surgery, Stanford University, 450 Broadway St., 94063, Redwood City, CA, USA

    Serena S. Hu MD

Authors
  1. Krishn Khanna MD
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  2. Frank Valone III MD
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  3. Alexander Tenorio BA
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  4. Trevor Grace MD
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  5. Shane Burch MD
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  6. Sigurd Berven MD
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  7. Bobby Tay MD
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  8. Vedat Deviren MD
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  9. Serena S. Hu MD
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Corresponding author

Correspondence to Serena S. Hu MD.

Additional information

Author disclosures: KK (none), FVIII (none), AT (none), Trevor Grace (none), SB (none), SB (personal fees from Medtronic, United States and Stryker Spine, United States; grants and personal fees from Globus Medical; personal fees from RTI, outside the submitted work), BT (none), VD (grants and other from NuVasive, United States; personal fees from Biomet, United States, Alphatec, Seaspine, Medicrea, and Pfizer, United States; grants from AOspine and Globus, outside the submitted work), SSH (royalties and stock from NuVasive).

IRB approval: The Institutional Committee on Human Research approved the study (IRB approval. no. 17-24051).

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Khanna, K., Valone, F., Tenorio, A. et al. Local Application of Vancomycin in Spine Surgery Does Not Result in Increased Vancomycin-Resistant Bacteria—10-Year Data. Spine Deform 7, 696–701 (2019). https://doi.org/10.1016/j.jspd.2019.01.005

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  • DOI: https://doi.org/10.1016/j.jspd.2019.01.005

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