Profilaxia infecciosa com aplicação local de vancomicina em pó em cirurgias ortopédicas: Revisão sistemática com metanálise

Abstract

Despite many existing strategies used to reduce the rates of surgical site infection (SSI), these are still fairly frequent complications that pose a challenge for orthopedic surgeons. Therefore, the search for more effective methods of perioperative infection prophylaxis became a main subject of research, with the goal of decreasing postoperative morbidity, mortality, and costs. Thus, the present study sought to assess the effectiveness of intra-wound vancomycin powder in orthopedic surgery SSI prophylaxis.A systematic review and meta-analysis study was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols 2015 (PRISMA-P 2015). A comprehensive literature search was performed to identify controlled studies on the rates of SSI with or without the local use of vancomycin powder. Exclusion and inclusion criteria were applied. A meta-analysis with random effects was performed.Out of 412 titles that met the criteria, 7 studies regarding spine surgery were included: 4 prospective and 3 retrospective studies. A total of 6,944 cases were identified, and they were divided into 2 groups: the control group (3,814 patients), to whom intrawound vancomycin was not administered, and the intervention group (3,130 patients), to who vancomycin was administered locally. We observed that 64 (2.04%) patients in the intervention group developed SSI, in contrast to 144 (3.75%) patients in the control group. The results of the meta-analysis showed that the local use of vancomycin powder had an statistically significant protective effect against SSI in cases of spine surgery, with a relative risk (RR) of 0.59 and a 95% confidence interval (95%CI) of 0.35–0.98.The use of prophylactic intrawound vancomycin powder has a protective effect against SSI in spine surgeries; however, further prospective trials are needed to endorse its use in orthopedic surgeries.

Physicochemical and Biological Properties of Vancomycin-Containing Antibacterial Polysaccharide Gels for Biocomposite Bone Implant Impregnation

“…Additionally, amikacin, used to protect heart valves and vascular bioprostheses from bacterial infection, is rarely used in traumatology and orthopedics. Vancomycin is considered a more suitable antibiotic for the treatment of osteomyelitis. − …”

Do Intrawound Antibiotics Reduce the Incidence of Surgical Site Infections in Pelvic and Lower-Limb Trauma Surgery? A Systematic Review and Meta-analysis

“…Recent meta-analyses have supported the use of intrawound antibiotic powder in spinal surgery in reducing postoperative SSIs; however, they are limited by heterogenous studies with low-to-moderate quality evidence. [6][7][8][9][10][11] There are currently limited studies analyzing the proposed benefits of local intrawound antibiotics in pelvic and lowerlimb trauma surgery. Patients requiring pelvic and lower-limb trauma surgery often have concurrent factors that increase their risk of developing SSIs such as associated soft-tissue injury, open fractures, and wound contamination.…”