Intrawound Vancomycin Powder Reduces Surgical Site Infections in Posterior Cervical Fusion

Caroom, Cyrus; Tullar, Jessica M.; Benton, E. Garrison; Jones, Jason R.; Chaput, Christopher D.

doi:10.1097/brs.0b013e31828fcfb5

Cited by 151 publications

(121 citation statements)

References 34 publications

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“…46 , 47 With the often uncontrolled empirical vancomycin use particularly during elective surgeries, resistance rates could be further driven, which has already been documented by the emergence of vancomycin resistant enterococci and vancomycin-intermediate S aureus (VISA). 2 , 48 , 49 Given the disease burden and adaptability of S. aureus to develop resistance to many classes of antibiotics, the development of effective vaccines would be highly desirable in curbing disease as well as reducing AMR.…”

Section: Vaccines In Late Stage Development With Potential To Reduce Amrmentioning

confidence: 99%

The role of vaccines in fighting antimicrobial resistance (AMR)

Jansen

Anderson

2018

Human Vaccines & Immunotherapeutics

107

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The problem of antimicrobial resistance (AMR) and the associated morbidity and mortality due to antibiotic resistant bacterial pathogens is not new. However, AMR has been increasing at an alarming rate with appearances of diseases caused by bacteria exhibiting resistance to not just one but multiple classes of antibiotics. The World Health Organization (WHO) supported by governments, health ministries and health agencies has formulated global action plans to combat the rise in AMR, supporting a number of proven initiatives such as antimicrobial stewardship, investments in development of new classes of antibiotics, and educational programs designed to eliminate inappropriate antibiotic use. Vaccines as tools to reduce AMR have historically been under-recognized, yet the positive effect in reducing AMR has been well established. For example Haemophilus influenzae type B (Hib) as well as Streptococcus pneumoniae (pneumococcal) conjugate vaccines have impressive track records in not only preventing life threatening diseases caused by these bacteria, but also reducing antibiotic use and AMR. This paper will describe the drivers of antibiotic use and subsequent development of AMR; it will make the case how existing vaccines are already participating in combatting AMR, describe future prospects for the role of new vaccines in development to reduce AMR, and highlight challenges associated with future vaccine development to combat AMR.

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Section: Vaccines In Late Stage Development With Potential To Reduce Amrmentioning

confidence: 99%

The role of vaccines in fighting antimicrobial resistance (AMR)

Jansen

Anderson

2018

Human Vaccines & Immunotherapeutics

107

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“…2,[17][18][19][20]27 Compared with lumbar surgeries, Gruskay et al showed that cervical fusion cases were associated with a significantly lower rate of infection (n = 5023, 4.3% vs 2.75%, p = 0.003), with posterior cervical fusion cases having a significantly higher rate of infection than anterior cervical cases (n = 2544, 6.0% vs 0.4%, p < 0.001). 5 Postoperative infections have a deleterious impact on patients, as they often require more hospitalizations, surgical procedures, and resultant increased economic burden.…”

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confidence: 99%

“…2,4,14,15,17,[20][21][22] A few cohort studies have looked at posterior cervical fusion cases and have reported significant reductions in the incidence of postoperative deep SSI rates from 10.9%-15.0% to 0%-2.5% after the introduction of perioperative vancomycin powder. 2,17,20 However, these studies were limited by small cohort patient sizes, with fewer than 172 total patients, and high control (nonvancomycin) postoperative SSI rates. Furthermore, a recent study published by Mariappan et al 11 highlighted the adverse systemic effects of locally applied vancomycin powder and questioned its effectiveness in reducing the incidence of postoperative spinal SSIs.…”

mentioning

confidence: 99%

“…1,6,7 Given the incidence of deep wound infections, several authors explored and subsequently published their results on locally applied prophylactic vancomycin antibiotic powder, in addition to systemic antibiotics, to reduce postoperative spinal SSIs. [2][3][4]9,[13][14][15][16][17][20][21][22]24 Perioperative vancomycin powder is an attractive option for additional prophylaxis against postoperative SSI due to its low cost and broad coverage. Numerous studies have shown that the addition of local vancomycin aBBreviatiONS BMI = body mass index; CDC = Centers for Disease Control and Prevention; COPD = chronic obstructive pulmonary disease; CTJ = cervicothoracic junction; EBL = estimated blood loss; MRSA = methicillin-resistant Staphylococcus aureus; SSI = surgical site infection.…”

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confidence: 99%

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Experience with intrawound vancomycin powder for posterior cervical fusion surgery

Martin¹,

Adogwa²,

Brown³

et al. 2015

SPI

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OBJECT Recent studies have reported that the local delivery of vancomycin powder is associated with a decrease in spinal surgical site infection. This retrospective cohort study compares posterior cervical fusion cases before and after the routine application of spinal vancomycin powder to evaluate the ability of local vancomycin powder to prevent deep wound infection after posterior cervical spinal fusion. METHODS Posterior cervical fusion spinal surgeries performed at a single institution were reviewed from January 2011 to July 2013. Each cohort's baseline characteristics, operative data, and rates of wound infection were compared. Associations between infection and vancomycin powder, with and without propensity score adjustment for risk factors, were determined using logistic regression. RESULTS A total of 289 patients (174 untreated and 115 treated with vancomycin powder) were included in the study. The cohorts were similar in terms of baseline and operative variables. No significant change in deep wound infection rate was seen between the control group (6.9%) and intervention group (5.2%, p = 0.563). Logistic regression, with and without propensity score adjustment, demonstrated that the use of vancomycin powder did not impact the development of surgical site infection (OR 0.743 [95% CI 0.270–2.04], p = 0.564) and (OR 0.583 [95% CI 0.198–1.718], p = 0.328), respectively. CONCLUSIONS Within the context of an ongoing debate on the effectiveness of locally administered vancomycin powder, the authors found no significant difference in the incidence of deep wound infection rates after posterior cervical fusion surgery with routine use of locally applied vancomycin powder. Future prospective randomized series are needed to corroborate these results.

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“…Moreover, experience from thoracic or spinal surgery, where local vancomycin has been applied, has not revealed any negative consequences [3,4].…”

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confidence: 99%

Local vancomycin in ACL reconstruction: a modern rationale (2016) for morbidity prevention and patient safety

Eriksson

Karlsson

2016

Knee Surg Sports Traumatol Arthrosc

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treatment has become the first line of treatment unless contraindicated.It is obvious that, with improved results in both the short and long term [function and risk of osteoarthritis (OA)] and a simultaneous reduced risk of complications and morbidity related to the procedure, more people could benefit from surgery. For this reason, reducing morbidity after ACL reconstructive procedures must be a significant part of the "ACL holy grail".The incidence of deep post-operative infection following an ACL reconstruction varies between 0.14 and 1.7 % in different studies [2,12]. The majority of the present studies report an incidence of just below 1 %. Moreover, there are some signs that hamstring grafts are slightly more likely to be infected compared with patellar tendon (BTB) grafts. In terms of pathogens, coagulase-negative staphylococcus (CNS) appears to be the dominant species, followed by staphylococcus aureus and propionebacterium acne. The most likely aetiology is graft contamination from the patient's own skin flora.The potential consequences of a deep infection can obviously be devastating, with the need for graft and hardware removal, and in many patients, a second stage ACL-R 4 to 6 months later. However, in most cases, repeated washouts and long-term antibiotics cure the infection, and the graft may survive. The two major concerns following deep infection after ACL-R are graft survival and long-term graft function, but also the increased likelihood of long-term OA. In a recent publication by Boström Windhamre et al. [1], 27 of 43 reported infected ACL-Rs were compared with matched controls in terms of activity, time to recovery and knee function. The infection rate was estimated at 0.98 %.The recovery time was significantly longer, and the Tegner activity level was lower, while the KOOS values at a mean of 60 months post-operatively revealed no ACL reconstruction (ACL-R) in 2016 still faces two major challenges. The first is to improve the surgical technique and consequently the overall results, and the second is to minimise the morbidity of the procedure. The fact is that, if significant improvements in both these areas can be achieved, we would most probably offer surgical treatment (repair or reconstruction) as the first line of treatment to most young and middle-aged patients sustaining an ACL rupture. This argument could be compared with tibial fractures or other traumatic conditions, where surgical

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Intrawound Vancomycin Powder Reduces Surgical Site Infections in Posterior Cervical Fusion

Abstract: 2.

Cited by 151 publications

References 34 publications

The role of vaccines in fighting antimicrobial resistance (AMR)

The role of vaccines in fighting antimicrobial resistance (AMR)

Experience with intrawound vancomycin powder for posterior cervical fusion surgery

Local vancomycin in ACL reconstruction: a modern rationale (2016) for morbidity prevention and patient safety

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