EFFICACY OF PROPHYLACTIC INTRAWOUND APPLICATION OF VANCOMYCIN POWDER IN PREVENTING SURGICAL SITE INFECTIONS IN SPINAL INSTRUMENTATION SURGERY
DOI:
https://doi.org/10.55519/JAMC-02-11179Keywords:
SSI, incidence, risk factors, preventionAbstract
Background: Surgical site infection (SSI) is always a matter of utmost concern in cases of spinal instrumentation in low-income countries. This study was conducted to determine the efficacy of local intrawound application of vancomycin powder in reducing postoperative SSI following Thoracolumbar-Sacral spinal instrumentation. Methods: This randomized controlled trial was done in the Department of Neurosurgery, Ayub Teaching Hospital Abbottabad from 1st July 2019 to 31st December 2021. Seventy-eight patients of either gender with an age range from 15 to 65 years, who were planned for posterior spinal instrumentation surgery (transpedicular screw fixation), were included in the study. Patients were divided into two equal groups, A (Vanco group) and B (control group). In addition to standard systemic prophylaxis, 1 gm of Vancomycin powder was applied over the implant in Group A patients. Results: The mean age of the patients in Group A was 36±16.6 while the mean age of patients in the group was 33.7±15.9 years. A statistically significant reduction of surgical site infection was observed in those who received a prophylactic intra-wound application of vancomycin powder (Vanco group) (5.2%) compared to the control group (20.5%). Conclusion: Intrawound vancomycin powder administration significantly decreases SSI following spinal instrumentation surgeries. Patients at high risk of infection are highly recommended as a candidate for this technique.References
Murphy EP, Curtin M, Shafqat A, Byrne F, Jadaan M, Rahall E. A review of the application of vancomycin powder to posterior spinal fusion wounds with a focus on side effects and infection. A prospective study. Eur J Orthop Surg Traumatol 2017;27(2):187–91.
Kim SH, Lee SG, Kim WK, Park CW, Son S. Prophylatic intrawound application of vancomycin powder in instrumented spinal fusion surgeries. Korean J Spine 2013;10(3):121–5.
Joaquin, Fernandes A, Milano, Buzetti J, Daniel, Walter J. Spine surgery - the use of vancomycin powder in surgical site for postoperative infection prevention. Rev Assoc Méd Bras (1992) 2018;64(8):663–9.
Morange-saussier V, Giraudeau B, Van der mee N, Lermusiaux P, Quentin R. Nasal carriage of methicillin resistant staphylococcus aureus in vascular surgery. Ann Vasc Surg 2006;20(6):767–72.
Dodson V, Majmundar N, Swantic V, Assina R. The effect of prophylactic vancomycin powder on the infection following spinal surgeries: a systematic review. Neurosurg Focus 2019;46(1);E1.
Xiong L, Pan Q, Jin G, Xu Y, Hirche C. Topical intrawound application of vancomycin powder in addition to intravenous administration of antibiotics: A meta-analysis on the deep infection after spinal surgeries. Orthop Traumatol Surg Res 2014;100(7):785–89.
Hanssen AD. Local antibiotic delivery vehicles in the treatment of musculoskeletal infection. Clin Orthop Relat Res 2005;437:91–6.
Markakis K, Faris AR, Sharaf H, Faris B, Rees S, Bowling FL. Local Antibiotic Delivery Systems: Current and Future Applications for Diabetic Foot Infections. Int J Low Extrem Wounds 2018;17(1):14–21.
Sweet FS, Roh M, Sliva C. Intra-wound application of vancomycin for prophylaxis in instrumented thoracolumbar fusions: efficacy, Drug levels, and patient outcomes. Spine 2011;36(24):2084–88.
Tailaiti A, Shang J, Shan S, Muheremu A. Effect of intrawound vancomycin application in spinal surgery on the incidence of surgical site infection: a meta-analysis. Ther Clin Risk Manag 2018;14:2149–59.
Lieber B, Han B, Strom RG, Mullin J, Frempong-Boadu AK, Agarwal N, et al. Preoperative predictors of spinal infection within the national surgical quality inpatient database. World Neurosurgery 2016;89:517–24.
Calderone RR, Garland DE, Capen DA, Oster H. Cost of medical care for postoperative spinal infections. Orthop Clin North Am 1996;27(1):171–82.
Olsen MA, Nepple JJ, Riew KD, Lenke LG, Bridwell KH, Mayfield J, et al. Risk factors for surgical site infection following orthopaedic spinal operations. J Bone Joint Surg Am 2008;90(1):62–9.
Weinstein MA, McCabe JP, Cammisa FP Jr. Post¬operative spinal wound infection: a review of 2,391 consecutive index procedures. J Spin Disord 2000;13(5):422–6.
Olsen MA, Mayfield J, Lauryssen C, Polish LB, Jones M, Vest J, et al. Risk factors for surgical site infection in spinal surgery. J Neurosurg 2003;98(2 Suppl):149–55.
Pesenti S, Pannu T, Andres-Bergos J, Lafage R, Smith J, Glassman S, et al. What are the risk factors for surgical site infection after spinal fusion? A met analysis. Eur Spine J 2018;27(10):2469–80.
Abdul-Jabbar A, Berven SH, Hu SS, Chou D, Mummaneni PV, Take Moto S, et al. Surgical site infections in spine surgery: identification of microbiologic and surgical characteristics in 239 cases. Spine 2013;38(22):E1425–31.
Tuba Ki VR, Rajasekaran S, Shetty AP. Effects of using intravenous antibiotic only versus local intrawound vancomycin antibiotic powder application in addition to intravenous antibiotics on postoperative infection in spine surgery in 907 patients. Spine (Phila Pa 1976) 2013;38(25):2149–55.
Dennis Hey HW, Thiam DW, Darren Koh ZS, Thambiah JS, Kumar N, Lau LL, et al. Is intraoperative local vancomycin powder the answer to surgical site infections in spine surgery? Spine (Phila Pa 1976) 2017;42(4):267–74.
Zebala LP, Chuntarapas T, Kelly MP, Talcott M, Greco S, Riew KD. Intrawound vancomycin powder eradicates surgical wound contamination: an in vivo rabbit study. J Bone Joint Surg Am 2014;96(1):46–51.
Armaghani SJ, Menge TJ, Lovejoy SA, Mencio GA, Martus JE. Safety of topical vancomycin for pediatric spinal deformity: nontoxic serum levels with supra therapeutic drain levels. Spine 2014;39(20):1683–87.
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