Vancomycin-impregnated calcium sulfate beads compared with vancomycin powder in adult spinal deformity patients undergoing thoracolumbar fusion

Abstract

Introduction Adult spinal deformity (ASD) surgery patients are at higher risk for surgical site infections (SSIs) due to large incisions, high blood loss, long surgical duration, and extensive instrumentation. The use of vancomycin powder has demonstrated inconsistent results in ASD surgery. Antibiotic-impregnated calcium sulfate beads have been used in arthroplasty and foot and ankle surgery with promising results. The purpose of this study was to provide preliminary data on the use of vancomycin-impregnated calcium sulfate beads in the prevention of SSI following ASD surgery and provide comparisons to the use of vancomycin powder. Methods A retrospective chart review was performed for 95 consecutive surgical ASD patients at a tertiary care center from January 2017 until March 2020. Patients received either vancomycin powder (powder group) or vancomycin-impregnated calcium sulfate beads (bead group) intrawound prior to closure. Patient demographics, operative course, and incidence of postoperative infections were recorded. A two-tailed chi-squared test was performed to compare infection rates. Results Ninety-five patients were included for review. Forty-two patients were in the powder group and 53 patients were in the bead group. The bead group was older (59.8 vs 67.8 years, p < 0.01) with similar BMI and rates of diabetes, smoking, and length of surgery. There were four postoperative SSI in the powder group requiring operative irrigation and debridement and one SSI in the bead group (9.5% vs 1.9%, p = 0.09). All infections occurred in the first 90 days of the postoperative period. Conclusion Preliminary examination of the use of vancomycin-impregnated calcium sulfate beads demonstrated a 1.9% surgical site infection rate in adult spinal deformity surgical patients, which was not significantly different compared with the 9.5% infection rate in patients who received vancomycin powder. Prospective study is needed to determine if the differences found are significant in a larger number of patients.

Does Nasal Screening for Methicillin-Resistant Staphylococcus aureus (MRSA) Prevent Deep Surgical Site Infections for Elective Cervical Spinal Fusion?

“…W ithin elective spine surgery, surgical site infections (SSIs) contribute significant morbidity and additional cost. 1,2 Multiple mechanisms have been proposed for prevention of SSIs including the use of intrawound vancomycin, 3 adjustment of perioperative antibiotics, or preoperative optimization and testing. [4][5][6] Among these, preoperative testing and decolonization for methicillinresistant Staphylococcus aureus (MRSA) is an attractive option because of promising results seen in other orthopedic subspecialties such as hip and knee arthroplasty, and several large studies have shown significant reduction in infection rates after implementation of screening and decolonization programs.…”

Does local vancomycin powder impregnated with autogenous bone graft and bone substitute decrease the risk of deep surgical site infection in degenerative lumbar spine fusion surgery?—An ambispective study

“…There have been many articles on the topical of local vancomycin to reduce the risk of infection after orthopaedic surgery [3,38,39]. Moreover, vancomycin impregnated bone graft has been also widely used in spinal surgery [40][41][42]. Therefore, a prospective randomized study with an adequate patient number is needed to clarify the benefits of vancomycin impregnated autogenous bone graft and bone substitute on preventing DSSI following degenerative lumbar spine fusion surgery.…”

Efficacy and safety of vancomycin-loaded calcium sulfate versus conventional surgical debridement for pediatric acute osteomyelitis: a retrospective study

“…Localized administration of antibiotics can be advantageous due to the ability to achieve a higher drug concentration at the infected site while limiting systemic toxicity as well as avoiding unwanted metabolic and pharmacokinetic effects that can reduce the efficacy of drug delivery. The localized delivery of antibiotic-loaded calcium sulphate beads has been investigated as a treatment option or prophylaxis for numerous orthopaedic disorders, such as periprosthetic joint infections, adult spinal deformity patients undergoing thoracolumbar fusion, adult chronic osteomyelitis, localized calcaneal osteomyelitis and diabetic foot osteomyelitis [4][5][6][7][8]. However, no studies exist in literature on the use of localized antibiotic delivery to treat AHOM in children.…”