Is Use of Topical Vancomycin in Pediatric Spine Surgeries a Safe Option in the Prevention of Surgical Site Infections? A Meta-analysis and Systematic Review of the Literature

Abstract

<jats:sec><jats:title>Study Design:</jats:title><jats:p> Systematic review and meta-analysis. </jats:p></jats:sec><jats:sec><jats:title>Objective:</jats:title><jats:p> To systematically review the available articles on topical vancomycin powder (TVP) use in pediatric spine surgeries exploring the usefulness and safety of such practice. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> We conducted an independent and duplicate electronic database search in PubMed, EMBASE, and Cochrane Library till March 2020 to identify all relevant literature on the use of TVP for pediatric spine surgeries. Surgical site infection (SSI) rate, specific reported complications, reoperation rate, microbial flora pattern in reported SSIs, and safety profile were the outcomes analyzed. Analysis was performed with the R platform using OpenMeta[Analyst] software. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> No prospective studies were available to evaluate the use of TVP in pediatric spine surgeries for the prevention of SSIs. Neither standardized protocol, nor drug dosage, nor safety profile was established for pediatric use. Three retrospective cohort studies including 824 patients (TVP/control: 400/424) were included in the meta-analysis. There was low-quality evidence suggesting no significant difference between the 2 groups in SSI rate (RR = 0.474; 95% CI = [0.106,2.112]; P = .327) with significant heterogeneity ( I <jats:sup>2</jats:sup> = 70.14; P = .035). The TVP group showed a significant benefit on cost analysis in one of the included studies. However, TVP did not prevent gram-negative coinfection on SSI in the TVP group. </jats:p></jats:sec><jats:sec><jats:title>Conclusion:</jats:title><jats:p> From the literature available at present, TVP does not qualify to be recommended as a safe and useful option to prevent SSI following pediatric spine surgeries. High-quality prospective interventional studies are needed to arrive at a consensus on its use along with appropriate dosage and method of application. </jats:p></jats:sec>

Intrawound vancomycin powder in orthopaedic surgery as surgical site wound infection prophylaxis: A meta‐analysis

“…This was also emphasised in former research that used a connected meta-analysis practice and originated comparable values of the impact. [32][33][34][35][36] Although the meta-analysis was unable to determine if differences in these variables are connected to the research outcomes, properly-led RCTs must take these factors into account in addition to the variety of diverse ages, genders, and ethnicities of people. In conclusion, IWVP had significantly lower SSWIs, deep SSWIs, and superficial SSWIs compared with control in persons with OPS.…”

“…More examination is still necessary to illuminate these possible impacts. This was also emphasised in former research that used a connected meta‐analysis practice and originated comparable values of the impact 32‐36 . Although the meta‐analysis was unable to determine if differences in these variables are connected to the research outcomes, properly‐led RCTs must take these factors into account in addition to the variety of diverse ages, genders, and ethnicities of people.…”

Vancomycin Flushing Syndrome After the Use of Vancomycin-Impregnated Bone Graft During Spine Surgery

“…Intrawound vancomycin in pediatric spine surgeries has been considered relatively safe in the pediatric age group as well. A 2017 study by the Children’s Spine Study Group reviewed 1,398 patients and reported only 1 possible adverse reaction in the form of rash without any systemic effects 19,20 . All the reports of adverse reactions are in adults with multiple comorbidities.…”

Intraoperative Antibiotic Use in Patients With Early-onset Scoliosis: Current Practices and Trends

“…17,18 While some studies have found topical vancomycin effective in preventing SSI after spine surgery, others have not found a significant decrease in SSIs with topical vancomycin in pediatric patients undergoing spine surgery. [19][20][21][22] Given that BPGs were published in September 2019, perhaps it is too early for consensus guidelines to have made a substantial impact on reducing variability in SSI prevention and prophylactic antibiotic use. Guidelines may impact patients on an institutional level not captured in the present study.…”

“…Therefore, some have advocated for restricted use in procedures and patients most at risk for infection 17,18. While some studies have found topical vancomycin effective in preventing SSI after spine surgery, others have not found a significant decrease in SSIs with topical vancomycin in pediatric patients undergoing spine surgery 19–22…”