Hyaluronan Preserves Peritoneal Membrane Transport Properties

2001 ◽  
Vol 21 (2) ◽  
pp. 136-143 ◽  
Author(s):  
Qun-Ying Guo ◽  
Wen-Xing Peng ◽  
Hui-Hong Cheng ◽  
Ren-Gao Ye ◽  
Bengt Lindholm ◽  
...  
Keyword(s):  
Membrane Transport ◽  
Peritoneal Fluid ◽  
Absorption Rate ◽  
Control Group ◽  
Fluid Absorption ◽  
Peritoneal Membrane ◽  
Lymphatic Absorption ◽  
Dialysis Solution ◽  
Significant Difference ◽  
And Control

Background We have shown that intraperitoneal (IP) addition of hyaluronan (HA) in a single dwell study in rat could increase peritoneal fluid removal by decreasing the peritoneal fluid absorption rate. In this study, we investigated the impact of repeated use of HA on peritoneal membrane transport characteristics. Methods Twelve male Sprague–Dawley rats received a once-daily IP injection of 25 mL 4.25% glucose dialysis solution without (HP group, n = 6) or with 0.025% HA (HA group, n = 6) for 1 week. Forty-eight hours after the last injection, a 4 hour dwell using 25 mL 4.25% glucose dialysis solution with IP volume marker and frequent dialysate and blood samplings was performed in each rat as well as in rats that did not receive any injection (control group, n = 8). Results Although the IP volumes were significantly lower in the HP and HA groups compared to the control group, IP volume in the HA group was significantly higher than in the HP group. Net ultrafiltration at 4 hours was 5.6 ± 1.3 mL, 10.2 ± 1.8 mL, and 13.2 ± 0.6 mL for the H P, HA, and control group, respectively. The peritoneal fluid absorption rate decreased by 45% in the HA group compared to the HP group. There was no significant difference in peritoneal fluid absorption rate between the HA and the control group. No difference was found in the direct lymphatic absorption rate between the HP and HA groups [0.010 ± 0.003 mL/minute in the HP group and 0.011 ± 0.004 mL/min in the HA group] although they were both higher than that of the control group (0.004 ± 0.001 mL/min). The solute transport rates were in general significantly higher in the HP group compared to the HA and control groups, and there was no significant difference between the latter two groups, except that protein transport rate was significantly lower in the HA group compared to the control group. Conclusions The present study suggests that ( 1 ) repeated exposure to hypertonic glucose-based dialysis solution results in increased peritoneal solute transport rates, as well as increased peritoneal fluid absorption rates; and ( 2 ) these changes, reflecting a highly permeable peritoneal membrane, were ameliorated by repeated IP addition of hyaluronan. The similar changes in the direct lymphatic absorption rate in rats that received daily IP injection of dialysis solution suggest that direct peritoneal lymphatic absorption was not influenced by hyaluronan.

Effects of Peritoneal Resting on Peritoneal Fluid Transport Kinetics

2007 ◽  
Vol 27 (5) ◽  
pp. 575-579 ◽  
Author(s):  
Xing-wei Zhe ◽  
Xin-kui Tian ◽  
Lei Cheng ◽  
Tao Wang
Keyword(s):  
Peritoneal Dialysis ◽  
Peritoneal Fluid ◽  
Absorption Rate ◽  
Fluid Transport ◽  
Fluid Absorption ◽  
Peritoneal Membrane ◽  
Dialysis Patients ◽  
Dialysis Solution ◽  
Before And After ◽  
Glucose Exposure

Background Peritoneal resting has been used to restore peritoneal ultrafiltration capacity in peritoneal dialysis patients. Therefore, in the present study, we made a detailed investigation on the effects of peritoneal resting on peritoneal fluid transport characteristics in patients on continuous ambulatory peritoneal dialysis (CAPD). Methods A temporary transfer to daytime ambulatory peritoneal dialysis with a nocturnal “empty belly” was applied to let the peritoneal membrane rest overnight in patients with poor ultrafiltration capacity. All included patients were asked to record appropriately their dialysis exchanges for the assessment of peritoneal fluid transport characteristics, which were evaluated before and after peritoneal resting. Results Seven CAPD patients were included in the present study. There was a significant improvement in peritoneal ultrafiltration capacity as assessed by ultrafiltration volume per gram of glucose load. Patients’ daily glucose exposure and dialysate-to-plasma ratio of creatinine were significantly decreased after peritoneal resting. The peritoneal fluid absorption rate was also significantly decreased after peritoneal resting: 1.011 ± 0.4484 versus 0.625 ± 0.3833 mL/minute. Conclusion The present study suggests that peritoneal resting can improve CAPD patients’ ultrafiltration capacity and decrease the use of hypertonic dialysis solution. The improved ultrafiltration capacity by peritoneal resting was due to decreased membrane solute transport rate and decreased peritoneal fluid absorption rate.

scholarly journals Hyaluronan decreases peritoneal fluid absorption in peritoneal dialysis.

1997 ◽  
Vol 8 (12) ◽  
pp. 1915-1920
Author(s):  
T Wang ◽  
C Chen ◽  
O Heimbürger ◽  
J Waniewski ◽  
J Bergström ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Peritoneal Fluid ◽  
Protein Transport ◽  
Intraperitoneal Administration ◽  
Control Group ◽  
Fluid Absorption ◽  
Sprague Dawley ◽  
Transfer Coefficients ◽  
Fluid Removal ◽  
Dialysis Solution

Hyaluronan, exhibiting a high resistance against water flow, acts in the tissue as a barrier against rapid changes in water content. To test whether hyaluronan has any effect on the peritoneal fluid and solute transport, and, in particular, on the peritoneal fluid absorption, a 4-h dwell study with an intraperitoneal volume marker (radiolabeled human serum albumin [RISA]) was conducted in 21 male Sprague Dawley rats (three groups, seven rats in each group). Each rat was injected intraperitoneally with 25 ml of 1.36% glucose solution alone (control group), with 0.005% hyaluronan (HA1 group), or with 0.01% hyaluronan (HA2 group). Dialysate and blood samples were taken frequently for analyses of fluid and solute (urea, glucose, and protein) transport. The intraperitoneal volume was calculated from the dilution of RISA with a correction for RISA disappearance from the peritoneal cavity. This study shows that adding hyaluronan to peritoneal dialysis solution significantly (P < 0.01) increased the net peritoneal fluid removal, mainly due to a significant decrease in the peritoneal fluid absorption rate (P < 0.01). The diffusive mass transfer coefficients for glucose, urea, and protein did not differ between the three groups. The peritoneal clearance of urea increased significantly in the two hyaluronan groups compared with the control group, due to the increased net fluid removal in the hyaluronan groups. These results suggest that intraperitoneal administration of hyaluronan during a single peritoneal dialysis exchange may significantly increase the peritoneal fluid and solute removal by decreasing peritoneal fluid absorption.

Peritoneal Fluid and Solute Transport with Different Polyglucose Formulations

1998 ◽  
Vol 18 (2) ◽  
pp. 193-203 ◽  
Author(s):  
Tao Wang ◽  
Olof Heimbürger ◽  
Hui-Hong Cheng ◽  
Jonas Bergström ◽  
Bengt Lindholm
Keyword(s):  
Solute Transport ◽  
Peritoneal Cavity ◽  
Peritoneal Fluid ◽  
Absorption Rate ◽  
Glucose Solution ◽  
Ex Vivo ◽  
Elimination Rate ◽  
Fluid Absorption ◽  
Significant Difference ◽  
Glucose Polymer

Objective To study peritoneal fluid and solute transport characteristics using different polyglucose solutions with and without the addition of glucose. Design Thirty-one rats were divided into three groups. A 4-hour dwell study with frequent dialysate and blood samples was performed in each rat using 25 mL of 7.5% polyglucose solution (PG, n = 11),7.5% polyglucose + 0.35% glucose solution (PG1, n = 12), or 3.75% polyglucose + 1.93% glucose solution (PG2, n = 8). Radiolabeled human albumin (RISA) was added to the solutions as an intraperitoneal volume (IPV) marker. In addition, polyglucose degradation was evaluated ex vivo over 24 hours. Experimental Animals Thirty-one male Sprague Dawley rats (300 g) were used. Main Outcome Measures Fluid and solute (glucose, urea, sodium, potassium, and total protein) transport characteristics as well as changes in dialysate osmolality were evaluated. Results The IPV was higher in the PG1 and PG2 groups than in the PG group during the first 2 hours of the dwell. The IPV, in fact, decreased during the first hour of the dwell in the PG group. However, the net ultrafiltration at 4 hours tended to be lower in the PG2 (3.2 ± 1.5 mL) group compared to the PG (5.1 ± 2.3 mL) and the PG1 groups (5.2 ± 2.1 mL) (p = 0.07), and no significant difference was found between the PG and PG1 groups. Adding glucose to the PG solution increased the RISA elimination rate (KE, representing the fluid absorption rate from the peritoneal cavity): 25.5 ± 8.2, 37.5 ± 12.2, and 42.5 ± 8.9 μL/ min for the PG, PG1, and the PG2 group, respectively, p < 0.01. Dialysate osmolality (Dos) increased with the dwell time in the PG and PG1 groups but decreased in the PG2 group. The increase in Dos was partially due to the degradation of glucose polymer, which was supported by the marked increase in osmolality over 24 hours of incubation of PG solution with peritoneal fluid, ex vivo. The diffusive mass transport coefficient for the investigated solutes did not differ among the three groups (except for glucose, which was significantly lower in the PG group). The sieving coefficient for sodium was significantly higher in the PG group compared to the PG1 group (p < 0.05). Conclusion Our results suggest that, although there was an initial decrease in the intraperitoneal dialysate volume, significant amounts of fluid can be removed by polyglucose solution during a single 4-hour dwell in rats, despite the low osmolality of the solution. The positive fluid removal induced by the PG solution is partially due to the lower fluid absorption rate associated with this solution and may, to some extent, also be due to the degradation of glucose polymer within the peritoneal cavity, resulting in increased dialysate osmolality. The addition of glucose to the polyglucose solution does not seem to improve ultrafiltration in a 4-hour dwell in the rat model. However, the peritoneal fluid absorption rate may be increased, and peritoneal transport of glucose and sodium may be altered, by adding glucose to the polyglucose solution.

Intraperitoneal Addition of Hyaluronan Improves Peritoneal Dialysis Efficiency

1999 ◽  
Vol 19 (2_suppl) ◽  
pp. 106-111 ◽  
Author(s):  
Tao Wang ◽  
Hui-Hong Cheng ◽  
Olof Heimbürger ◽  
Chi Chen ◽  
Jacek Waniewski ◽  
...  
Keyword(s):  
Peritoneal Fluid ◽  
Absorption Rate ◽  
Glucose Solution ◽  
Control Group ◽  
Fluid Absorption ◽  
High Concentration ◽  
Control Groups ◽  
Fluid Removal ◽  
Molecular Weights ◽  
Fill Volume

Background It has been shown that hyaluronan (HA) can decrease peritoneal fluid absorption. It is not known, however, how various molecular weights and various concentrations of hyaluronan affect peritoneal fluid absorption rate. Methods A study of 4-hour dwells, with frequent dialysate and blood sampling, was performed in male SpragueCawley rats (6 7 rats in each group) with 1311 albumin as an intraperitoneal volume marker. Each rat was infused intraperitoneally with 25 mL of 1.5% glucose solution alone or 1.5% glucose solution containing hyaluronan at various molecular weights (MW -85 kC, 280 kC, 500 kC, and 4 MC) or containing hyaluronan of MW 500 kC at various concentrations (0.01%,0.05%,0.1%,0.5%). Two additional groups were infused with 40 mL of 1.36% glucose dialysate alone or 1.36% glucose dialysate with 0.01 % hyaluronan (MW 500 kC) to test the effect of hyaluronan when high dialysate fill volume was used. Results Addition of 0.01% hyaluronan significantly decreased peritoneal fluid absorption rate (KE) (by 22%, p < 0.01). The decrease was more marked with hyaluronan at high MW or high concentration, or with high dialysate fill volume. The net ultrafiltration tended to be higher in all hyaluronan groups compared to their control groups except in the 4 MC group; this difference was mainly due to a lower KE in all the hyaluronan groups. The direct lymphatic flow was significantly decreased in the 0.5% HA group. The transcapillary ultrafiltration rate (au) was significantly lower in the 4 MC group as compared to the control group. No difference in au was found between the other groups as compared to their control groups. Conclusions (1) Intraperitoneal addition of hyaluronan may increase net peritoneal fluid removal, mainly because hyaluronan decreases peritoneal fluid absorption rate. The decrease was more marked when high dialysate fill volume was used, indicating that intraperitoneal addition of hyaluronan can prevent the decreased net ultrafiltration caused by an increase in dialysate fill volume. (2) The decrease in peritoneal fluid absorption rate may be both MW-dependent and concentration-dependent: that is, a higher MW as well as a higher concentration of hyaluronan result in a more marked decrease in peritoneal fluid absorption rate. (3) Low concentrations of high MW hyaluronan may also decrease au. However, au did not decrease when high concentrations of hyaluronan were used despite a significant decrease in peritoneal fluid absorption rate.

Structural and Functional Alterations of the Peritoneum after Prolonged Exposure to Dialysis Solutions: Role of Aminoguanidine

2001 ◽  
Vol 21 (3) ◽  
pp. 245-253 ◽  
Author(s):  
Eun Ah Lee ◽  
Jong Hoon Oh ◽  
Hyun Ah Lee ◽  
Sung Il Kim ◽  
Eung Woo Park ◽  
...  
Keyword(s):  
High Glucose ◽  
Peritoneal Fluid ◽  
Absorption Rate ◽  
Prolonged Exposure ◽  
Control Group ◽  
Fluid Absorption ◽  
Plasma Urea ◽  
Capillary Formation ◽  
Vascular Walls

Objective The effect of long-term use of high glucose dialysate on peritoneal structure and function, and its relation with accumulation of advanced glycosylation end-product (AGE) in the peritoneum was investigated in this study. Methods Dialysates with 4.25% glucose were injected into the peritoneal cavity of normal rats for 12 weeks without (PD, n = 7) and with (1 g/L, PD+AG, n = 7) aminoguanidine in their drinking water. Rats not having intraperitoneal (IP) injection served as control ( n = 9). After 12 weeks of IP injection, a 2-hour peritoneal equilibration test (PET) was performed using 30 mL 4.25% glucose dialysate. Intraperitoneal volume (IPV), dialysate-to-plasma urea ratio at 2 hours (D2/P2), the ratio of dialysate glucose at 2 hours to initial dialysate glucose (D2/D0), and the peritoneal fluid absorption rate (Qa) were evaluated. After the PET, samples of the parietal peritoneum were taken for hematoxylin and eosin (H&E) staining and immunohistochemical staining for AGE. Results The IPV and D2/D0 glucose were significantly lower and Qa and D2/P2 urea significantly higher in the PD group than in the control group. Aminoguanidine reversed in part the changes in IPV and D2/P2 urea in the PD group; it had no effect on Qa and D2/D0 glucose. The H&E staining showed a linear mesothelial lining with negligible cells and capillaries in the narrow submesothelial space in the control group. Mesothelial denudation and submesothelial infiltration of monocytes and capillary formation were observed in the PD group. Mesothelial denudation was relatively intact in the PD+AG group compared with the PD group. Submesothelial monocyte infiltration and capillary formation in the PD+AG group were not as prominent as in the PD group. Positive AGE staining was found in the submesothelial space, vascular walls, and endomysium in the PD group, while it was markedly attenuated in PD+AG group and negligible in the control group. Conclusion Long-term use of high glucose solutions induced peritoneal AGE accumulation and mesothelial denudation, and increased peritoneal permeability and peritoneal fluid absorption rate. Inhibition of peritoneal AGE accumulation prevented those functional and structural damages to the peritoneum.

Peritoneal Transport of Glucose in Rat

1999 ◽  
Vol 19 (5) ◽  
pp. 442-450 ◽  
Author(s):  
Min Sun Park ◽  
Eun Young Lee ◽  
Gyo Il Suh ◽  
Jacek Waniewski ◽  
Andrzej Werynski ◽  
...  
Keyword(s):  
Glucose Transport ◽  
High Glucose ◽  
Peritoneal Fluid ◽  
Absorption Rate ◽  
Convective Transport ◽  
Control Group ◽  
Fluid Absorption ◽  
Sprague Dawley ◽  
High Insulin ◽  
Group 2

Objective To evaluate the convective transport characteristics of glucose and the effect of high glucose and insulin during experimental peritoneal dialysis in rat. Methods Male Sprague–Dawley rats weighing 300 – 400 g were used in this study. Mannitol (5%) was used as osmotic agent. Glucose was added to dialysis solution to yield a concentration of 100 mg/dL (group 1) or 300 mg/dL (group 2). Mannitol solution (5%) containing the same concentration of electrolytes and lactate but without glucose was used as control (group 3). In group 2, blood sugar was maintained at approximately 300 mg/dL by continuous intravenous infusion of 25% glucose solution and 0.9% NaCl solution. A 2-hour dwell study was performed with 30 mL of test solutions. Intraperitoneal volume was calculated by volume marker (18.5 kBq of 131I-human radioiodinated serum albumin, RISA) dilution with corrections made for the elimination of RISA from the peritoneal cavity (KE) and sample volume. The diffusive mass transport coefficient (KBD) and sieving coefficient (SBRF) were calculated by using the Babb–Randerson–Farrell model. S was also calculated directly by using isocratic methods (SI). The peritoneal fluid absorption rate (KE) was taken into account for the calculation of SI. Results Intraperitoneal volume was significantly higher in group 2 compared with groups 1 and 3. Peritoneal fluid absorption rate, KE, was similar in all three groups. SBRF and SI for glucose were significantly lower in group 2 compared with groups 1 and 3. SBRF for glucose in group 2 was below zero and SI near zero. KBD for glucose was significantly higher in group 2 than in groups 1 and 3. Plasma and dialysate concentrations of insulin increased during the initial hour and then decreased to the baseline value in groups 1 and 3, while in group 2 it continuously increased. Conclusion Significantly lower sieving coefficients for glucose in the high glucose and high insulin group suggest that transport mechanisms other than simple passive transport are involved in peritoneal glucose transport, and that high glucose per se and/or high insulin may be important factors that determine glucose transport characteristics.

Effects of Virgin Coconut Oil as Adjunct Therapy in the Treatment of Allergic Rhinitis

2016 ◽  
Vol 1 (1) ◽  
pp. 22
Author(s):  
Nazli Zainuddin ◽  
Nurul Azira Mohd Shah ◽  
Rosdan Salim
Keyword(s):  
Allergic Rhinitis ◽  
Side Effects ◽  
Coconut Oil ◽  
Test Group ◽  
Nasal Symptom ◽  
Control Group ◽  
Virgin Coconut Oil ◽  
Control Groups ◽  
Significant Difference ◽  
And Control

Introduction: The role of virgin coconut oil in the treatment of allergic rhinitis is controversial. Thus, the aim of the present study is to determine the effects of virgin coconut oil ingestion, in addition to standard medications, on allergic rhinitis. We also studied the side effects of consumption of virgin coconut oil. Methods: Fifty two subjects were equally divided into test and control groups. All subjects received a daily dose of 10mg of loratadine for 28 days. The test group was given 10ml of virgin coconut oil three times a day in addition to loratadine. The symptoms of allergic rhinitis were scored at the beginning and end of the study. Results:, the symptom score were divided into nasal and non-nasal symptom scores. Sneezing score showed a significant difference, however the score was more in control group than test group, indicating that improvement in symptom was more in control group. The rest of the nasal symptom and non-nasal symptom score showed no significant difference between test and control groups. Approximately 58% of the test subjects developed side effects from consumption of virgin coconut oil, mainly gastrointestinal side effects. Conclusion: In the present study, ingestion of virgin coconut oil does not improve the overall and individual symptoms of allergic rhinitis, furthermore it has side effects.

Enrichment of common carp (Cyprinus carpio) diet with Malic acid: Effects on skin mucosal immunity, antioxidant defecne and growth performance

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Roghieh Safari ◽  
Seyed Hossein Hoseinifar ◽  
Maryam Dadar ◽  
Hien Van Doan
Keyword(s):  
Common Carp ◽  
Cyprinus Carpio ◽  
Malic Acid ◽  
Control Group ◽  
Skin Mucus ◽  
Antioxidant Genes ◽  
Treatment Comparison ◽  
Genes Expression ◽  
Significant Difference ◽  
And Control

AbstractThe present study investigated possible effects of dietary malic acid on the expression of immunity, antioxidant and growth related genes expression as well as skin mucus immune parameters in common carp. Common carp (Cyprinus carpio) fingerlings were fed diets supplemented with different levels (0 [control], 0.5%, 1%, 2%) of malic acid (MA) for 60 days. The results revealed highest expression levels of immune-related genes (tnf-alpha, il1b, il8 and lyz) in skin of common carp fed 2% MA (P < 0.05). Regarding 1% MA treatment comparison with control group, significant difference was noticed just in case of lyz (P < 0.05). Evaluation of growth related genes expression revealed no significant difference between treatments (P > 0.05). The study of antioxidant related genes (gsta and gpx) in common carp skin fed with MA, showed significant difference between treated groups and control (P < 0.05). Carps fed with 2% MA had highest alkaline phosphatase activity in skin mucus compared other treated groups and control (P < 0.05). There were no significant difference between 0.5% and 1% and control (P > 0.05). The study of total protein and total immunoglobulin (Ig) in common carp skin musus revealed no alteration following MA treatment (P > 0.05). The present data demonstrated that feeding with MA altered immune and antioxidant genes expression in skin mucus of common carp.

THE EFFECT OF THE ATTITUDE TOWARD BREASTFEEDING CONCEPT BASED COMIC ON THE ADOLESCENCE'S ATTITUDE TOWARD EXCLUSIVE BREASTFEEDING

2017 ◽  
Vol 1 (2) ◽  
pp. 138
Author(s):  
Mekar Dwi Anggraeni ◽  
Lutfatul Latifah ◽  
Aprilia Kartikasari ◽  
Ima Rismawati
Keyword(s):  
Exclusive Breastfeeding ◽  
Nuclear Family ◽  
T Test ◽  
Breastfeeding Duration ◽  
Control Group ◽  
Marriage Age ◽  
First Marriage ◽  
Significant Difference ◽  
Post Test ◽  
And Control

Background and purpose: The earlier development of the attitude toward exclusive breastfeeding produces the longer exclusive breastfeeding duration. Considering the first marriage age among Indonesian, the attitude toward exclusive breastfeeding should be developed at the adolescence age. The purpose of this study was to examine the effect of the attitude toward breastfeeding concept based comic on the adolescent's attitude toward exclusive breastfeeding. Method: This was a quasy experimental posttest only with control group study. The respondents were provided an comic. The respondent's attitude toward exclusive breastfeeding was measured using The Breastfeeding Attitude Questionnaire. Data were analyzed using independent and dependent t test. Results: The majority of respondents were aged 17 years old in both intervention (70%) and control grup (63%), first child in both intervention (23,3%) and control grup (26,7%), and had a nuclear family in both intervention (80%) and control grup (90%). The independent t test showed that there was a significant difference between post-test scores among the intervention and control groups (t = 5,602, p < 0,01). Conclusion and recommendation: Nurses may use the Attitude Toward Breastfeeding based comic to increase the Adolescence's attitude toward breastfeeding.Keywords: Comic, Attitudes Toward Exclusive Breastfeeding, Adolescence

Impact of intrawound vancomycin powder on prevention of surgical site infection after posterior spinal surgery

2021 ◽  
pp. 1-9
Author(s):  
Hiroki Ushirozako ◽  
Tomohiko Hasegawa ◽  
Yu Yamato ◽  
Go Yoshida ◽  
Tatsuya Yasuda ◽  
...  
Keyword(s):  
Propensity Score ◽  
Spinal Surgery ◽  
Control Group ◽  
Control Groups ◽  
Propensity Score Model ◽  
Significant Difference ◽  
Surgical Data ◽  
Vancomycin Powder ◽  
Vancomycin Group ◽  
And Control

OBJECTIVESurgical site infection (SSI) after posterior spinal surgery is one of the severe complications that may occur despite administration of prophylactic antibiotics and the use of intraoperative aseptic precautions. The use of intrawound vancomycin powder for SSI prevention is still controversial, with a lack of high-quality and large-scale studies. The purpose of this retrospective study using a propensity score–matched analysis was to clarify whether intrawound vancomycin powder prevents SSI occurrence after spinal surgery.METHODSThe authors analyzed 1261 adult patients who underwent posterior spinal surgery between 2010 and 2018 (mean age 62.3 years; 506 men, 755 women; follow-up period at least 1 year). Baseline and surgical data were assessed. After a preliminary analysis, a propensity score model was established with adjustments for age, sex, type of disease, and previously reported risk factors for SSI. The SSI rates were compared between patients with intrawound vancomycin powder treatment (vancomycin group) and those without (control group).RESULTSIn a preliminary analysis of 1261 unmatched patients (623 patients in the vancomycin group and 638 patients in the control group), there were significant differences between the groups in age (p = 0.041), body mass index (p = 0.013), American Society of Anesthesiologists classification (p < 0.001), malnutrition (p = 0.001), revision status (p < 0.001), use of steroids (p = 0.019), use of anticoagulation (p = 0.033), length of surgery (p = 0.003), estimated blood loss (p < 0.001), and use of instrumentation (p < 0.001). There was no significant difference in SSI rates between the vancomycin and control groups (21 SSIs [3.4%] vs 33 SSIs [5.2%]; OR 0.640, 95% CI 0.368–1.111; p = 0.114). Using a one-to-one propensity score–matched analysis, 444 pairs of patients from the vancomycin and control groups were selected. There was no significant difference in the baseline and surgical data, except for height (p = 0.046), between both groups. The C-statistic for the propensity score model was 0.702. In the score-matched analysis, 12 (2.7%) and 24 (5.4%) patients in the vancomycin and control groups, respectively, developed SSIs (OR 0.486, 95% CI 0.243–0.972; p = 0.041). There were no systemic complications related to the use of vancomycin.CONCLUSIONSThe current study showed that intrawound vancomycin powder was useful in reducing the risk of SSI after posterior spinal surgery by half, without adverse events. Intrawound vancomycin powder use is a safe and effective procedure for SSI prevention.

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