Does Addition of Tobramycin Powder Reduce Infection Rates After Spine Surgery?

Abstract

Study Design: Retrospective chart review.Objectives: To evaluate the efficacy of tobramycin and vancomycin powder in reducing surgical site infections in posterior lumbar instrumented fusion. Methods: A multicenter, electronic database search was conducted for all patients who underwent posterior instrumented lumbar fusions.Results: The addition of vancomycin powder decreased postoperative infections from an incidence of 5.7% down to a rate of 2.0%. This difference was statistically significant (P ¼ .018). The addition of tobramycin powder to the wound in addition to vancomycin further decreased the infection rate down to 1.8%. The postoperative infection rate was statistically significant (P ¼ .041) when compared with the no-powder group. However, the difference was not statistically significant (P ¼ 1.00) when compared with vancomycin alone. There was also a trend toward gram-negative organisms with the addition of more antibiotic powder. In the control group, for example, the organisms cultured were 66% methicillinsensitive Staphylococcus aureus and 33% gram-negative organisms. In the vancomycin group, 30% of the organisms cultured were Staphylococcus aureus and 60% gram-negative organisms. In the vancomycin and tobramycin powder group, 100% of the organisms cultured were gram-negative. Conclusions: There is a reduction in surgical site infections with addition of antibiotic powder to the wound prior to closure. However, the reduction in the infection rate was not as great with the addition of tobramycin powder to vancomycin alone and there was a noticeable change in the spectrum of organism cultured with this addition. Clinicians should consider the risk-tobenefit ratio in each case when deciding to use antibiotic powder.

Supratherapeutic Antibiotic Levels and Acute Kidney Injury from Absorption of Topical Antibiotics

“…A small number of spine surgery studies have suggested that the addition of Gram-negative coverage, such as the use of tobramycin, is required to reduce the SSI rate 11,18 . However, Lee et al recently evaluated the addition of topical tobramycin and found no difference in rates of infection 19 . With these conflicting reports, the Major Extremity Trauma Research Consortium group designed the Local Antibiotic Therapy to Reduce Infection After Operative Treatment of Fractures at High Risk of Infection (VANCO) trial as a high-quality prospective randomized controlled study to evaluate the efficacy of topical vancomycin in orthopaedic trauma surgery.…”

Exploring Penicillin G as an Intrawound Antibiotic Powder for Prevention of Postoperative Shoulder Infections: Does It Exhibit In Vitro Chondrotoxicity?

“…They found considerable variation among all factors, demonstrating no clear consensus on SSI prevention in shoulder arthroplasty even among a homogenous group of surgeons 28 To combat SSI the intraoperative usage of topical antibiotic powder has gained considerable attention. Previous studies have investigated the use of topical vancomycin, [42][43][44] gentamicin, 45 and tobramycin 46 for a range of orthopedic surgical indications. Vancomycin is the most commonly utilized local antibiotic in powder form within orthopedic surgery and has been the source of multiple previous studies on prevention of SSIs.…”

Effect of Local Delivery of Vancomycin and Tobramycin on Bone Regeneration

“…Vrabec et al 14 evaluated the local concentration of tobramycin in an in vivo study and found that local tobramycin bone cement can be used to obtain short-term supratherapeutic local concentrations in the surgical site while maintaining minimum serum tobramycin levels. A recent study proved that the topical application of tobramycin combined with vancomycin powder further reduced the infection rate than vancomycin alone 15 .…”