Prophylactic intraoperative powdered vancomycin and postoperative deep spinal wound infection: 1,512 consecutive surgical cases over a 6-year period

Abstract

15 of the 1,512 patients (0.99%) were identified as having evidence of postoperative deep wound infection. At least one pre-existing risk factor for deep infection was present in 8/15 pts (54%). Staphylococcus aureus and methicillin-resistant S. aureus (MRSA) were the most commonly identified organisms (11/15 cases). The rate of deep wound infection was 1.20% (8/663) for instrumented spinal surgeries, and 0.82% (7/849) for uninstrumented surgeries. Deep infection occurred in only 1.23% (4/324) of multilevel instrumented posterior spinal fusions, 1.37% (1/73) of open PLIF procedures, and 1.23% (1/81) of single-level instrumented posterior fusions. Deep infection was not observed in any patient who had uninstrumented spinal fusion (0/64). The deep infection rate for revision surgeries was 1.15% (1/87) and 0.55% (1/183) for trauma surgery. Increased rates of complications related to powdered vancomycin use were not identified in this series. Conclusion In this series of 1,512 consecutive spinal surgeries, the use of 1 g of powdered intraoperative vancomycin placed in the wound prior to wound closure appears to associated with a low rate deep spinal wound infection for both instrumented and uninstrumented cases. Rates of deep infection for instrumented fusion surgery, trauma, and revision surgery appear to be among the lowest reported in the existing literature. Further investigation of this prophylactic adjunctive measure is warranted.

Neuromuscular scoliosis complication rates from 2004 to 2015: a report from the Scoliosis Research Society Morbidity and Mortality database

“…35 Literature such as that from the North American Spine Society has confronted topics such as patient education, nutritional status, and antibiotic prophylaxis, while other studies are surfacing on interwound antibiotic application, implants, and surgical approach benefits. 1,10,11,24,28,32,34 In 2012, the SRS began recording data regarding antibiotics, wound washout, and microorganisms. All data given as percentages.…”

“…There is great variation in the literature about bacterial speciation, but these are the main organisms consistently reported. 24,36,41 Continued insight into their prevalence can guide management principals.…”

“…There are no largescale studies to examine the mechanisms behind this phenomenon, but some working hypotheses may attribute it partly to the use of vancomycin powder, difference in technique, and titanium/cobalt chrome implants. 1,10,11,24,32 These variations likely prevent the growth of interwound bacteria and decrease mechanical implant failure.…”

Experience with intrawound vancomycin powder for posterior cervical fusion surgery

“…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.…”

“…Numerous studies have shown that the addition of local vancomycin powder to standard systemic antibiotic prophylaxis reduced postoperative spinal SSI rates from 2.6%-15% to 0%-2.5%. 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.…”