Effectiveness of vancomycin powder for preventing postoperative spinal infection

• Published in: Clinical neurology and neurosurgery Vol. 239; p. 108222
• Main Authors: Choi, Sung-Woo, Hwang, Jin Yeong, Baek, Min Jung, Lee, Jae Chul, Jang, Hae-Dong, Kim, Jae-Hyun, Shin, Byung Joon
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01-04-2024; Elsevier Limited
• Subjects: Antibiotics; Back surgery; Costs; Debridement; Demographics; Diabetes mellitus; Disease prevention; Infectious diseases; Organisms; Orthopedics; Pathogens; Patient safety; Posterior spine fusion surgery; Postoperative spinal infection; Regression analysis; Resistant organism; SSI prophylaxis; Staphylococcus infections; Surgeons; Surgical site infections; Transplants & implants; Vancomycin; Vancomycin powder; Variables; Resistant organism; SSI prophylaxis; Posterior spine fusion surgery; Vancomycin powder; Postoperative spinal infection
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2024.108222

This study aimed to assess the effectiveness of Vancomycin Power (VP) and the occurrence of resistant organisms after four-year of routine VP use.
The study included 1063 patients who underwent posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) between January 2010 and February 2020. Intrawound VP was applied to all instrumented fusions starting in January 2016. The patients were divided into two groups: those who did not apply VP (non-VP) (n = 605) between 2010 and 2015, and those who did apply VP (VP) (n = 458) between 2016 and 2020. The baseline characteristics, clinical symptoms, infection rate, and causative organisms were compared between the two groups.
The rate of PSI was not significantly different between the non-VP group (1.32 %, n = 8) and the VP group (1.09 %, n = 5). Although adjusted by diabetes mellitus, VP still did not show statistical significance (OR = 0.757 (0.245–2.345), p = 0.630). There were no critical complications that were supposed to relation with vancomycin powder. In the 13 cases of PSI, seven pathogens were isolated, with a gram-negative organism identified in the non-VP group. However, the type of organism was not significantly different between the two groups.
The use of intrawound VP may not affect the PSI and occurrence of resistant organism and may not cause critical complications. Therefore, clinicians may decide whether to use VP for preventing PSI not worrying about its safety.
●The rate of postoperative spinal infection was not significantly different between the non-VP and the VP group.●The routine use of intrawound VP may not affect the PSI and occurrence of resistant organism.●The use of intrawound VP may not cause critical complication●VP may not adversely affect patients, and clinician can be confident about its safety.