scholarly journals Current Strategies in Prevention of Postoperative Infections in Spine Surgery

2019 ◽  
Vol 10 (2) ◽  
pp. 183-194 ◽  
Author(s):  
Kivanc Atesok ◽  
Efstathios Papavassiliou ◽  
Michael J. Heffernan ◽  
Danny Tunmire ◽  
Irina Sitnikov ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Surgical Site Infections ◽  
Supplemental Oxygen ◽  
Tight Glycemic Control ◽  
Infection Prophylaxis ◽  
Preventive Strategies ◽  
Level Of Evidence ◽  
Skin Preparation ◽  
Vancomycin Powder ◽  
High Level

Study Design:Narrative review.Objectives:Postoperative surgical site infections (SSIs) are among the most common acute complications in spine surgery and have a devastating impact on outcomes. They can lead to increased morbidity and mortality as well as greater economic burden. Hence, preventive strategies to reduce the rate of SSIs after spine surgery have become vitally important. The purpose of this article was to summarize and critically analyze the available evidence related to current strategies in the prevention of SSIs after spine surgery.Methods:A literature search utilizing Medline database was performed. Relevant studies from all the evidence levels have been included. Recommendations to decrease the risk of SSIs have been provided based on the results from studies with the highest level of evidence.Results:SSI prevention occurs at each phase of care including the preoperative, intraoperative, and postoperative periods. Meticulous patient selection, tight glycemic control in diabetics, smoking cessation, and screening/eradication of Staphylococcus aureus are some of the main preoperative patient-related preventive strategies. Currently used intraoperative measures include alcohol-based skin preparation, topical vancomycin powder, and betadine irrigation of the surgical site before closure. Postoperative infection prophylaxis can be performed by administration of silver-impregnated or vacuum dressings, extended intravenous antibiotics, and supplemental oxygen therapy.Conclusions:Although preventive strategies are already in use alone or in combination, further high-level research is required to prove their efficacy in reducing the rate of SSIs in spine surgery before evidence-based standard infection prophylaxis guidelines can be built.

scholarly journals The Use of Vancomycin Powder for Surgical Prophylaxis Following Craniotomy

Neurosurgery ◽  
2017 ◽  
Vol 80 (5) ◽  
pp. 754-758 ◽  
Author(s):  
Vinod Ravikumar ◽  
Allen L. Ho ◽  
Arjun V. Pendharkar ◽  
Eric S. Sussman ◽  
Kevin Kwong-hon Chow ◽  
...  
Keyword(s):  
Ad Hoc ◽  
Cost Savings ◽  
Surgical Site Infections ◽  
Control Group ◽  
Infection Prophylaxis ◽  
Potential Cost Saving ◽  
Infection Rates ◽  
Surgical Prophylaxis ◽  
Potential Cost ◽  
Vancomycin Powder

Abstract BACKGROUND: Intrawound vancomycin powder has been studied extensively in spinal fusion surgeries and been found to reduce rates of surgical site infections (SSIs) significantly. Despite its success in spinal surgeries, topical vancomycin has not been extensively studied with respect to cranial neurosurgery. OBJECTIVE: To evaluate the efficacy of intrawound topical vancomycin for prevention of SSIs following open craniotomies. METHODS: We retrospectively analyzed a large series of 350 patients from 2011 to 2015 in a pre/postintervention study of use of topical vancomycin to reduce postoperative craniotomy infection rates. We had a preintervention control group of 225 patients and a postintervention group of 125 patients that received intrawound topical vancomycin. RESULTS: Our preintervention incidence of SSI was 2.2% and this was significantly reduced to 0% following introduction of topical vancomycin (P < .5). An ad hoc cost analysis suggested a cost savings of ${\$}$59 965 with the use of topical vancomycin for craniotomies. CONCLUSION: Our study found a significant reduction in SSI rates after introduction of topical vancomycin. Thus, this simple intervention should be considered in all open craniotomy patients as both infection prophylaxis and a potential cost saving intervention.

Does Vancomycin Powder Decrease Surgical Site Infections in Growing Spine Surgery?

2018 ◽  
Vol 100 (6) ◽  
pp. 466-471 ◽  
Author(s):  
George H. Thompson ◽  
Connie Poe-Kochert ◽  
Christina K. Hardesty ◽  
Jochen Son-Hing ◽  
R. Justin Mistovich
Keyword(s):  
Spine Surgery ◽  
Surgical Site Infections ◽  
Vancomycin Powder ◽  
Growing Spine

scholarly journals Surgical Site Infection Prevention Following Spine Surgery

2020 ◽  
Vol 10 (1_suppl) ◽  
pp. 92S-98S ◽  
Author(s):  
Ilyas S. Aleem ◽  
Lee A. Tan ◽  
Ahmad Nassr ◽  
K. Daniel Riew
Keyword(s):  
Literature Review ◽  
Surgical Site Infection ◽  
Spine Surgery ◽  
Antimicrobial Prophylaxis ◽  
Tight Glycemic Control ◽  
Site Infection ◽  
Skin Preparation ◽  
Cervical Spine Surgery ◽  
Cervical Surgery ◽  
Posterior Cervical Surgery

Study Design: Literature review. Objectives: Surgical site infection (SSI) following spine surgery leads to significant patient morbidity, mortality, and increased health care costs. The purpose of this article is to identify risk factors and strategies to prevent SSIs following spine surgery, with particular focus on avoiding infections in posterior cervical surgery. Methods: We performed a literature review and synthesis to identify methods that can be used to prevent the development of SSI following spine surgery. Specific pearls for preventing infection in posterior cervical spine surgery are also presented. Results: SSI prevention can be divided into patient and surgeon factors. Preoperative patient factors include smoking cessation, tight glycemic control, weight loss, and nutrition optimization. Surgeon factors include screening and treatment for pathologic microorganisms, skin preparation using chlorhexidine and alcohol, antimicrobial prophylaxis, hand hygiene, meticulous surgical technique, frequent irrigation, intrawound vancomycin powder, meticulous multilayered closure, and use of closed suction drains. Conclusion: Prevention of SSI following spine surgery is multifactorial and begins with careful patient selection, preoperative optimization, and meticulous attention to numerous surgical factors. With careful attention to various patient and surgeon factors, it is possible to significantly reduce SSI rates following spine surgery.

The efficacy of intrawound vancomycin powder and povidone-iodine irrigation to prevent surgical site infections in complex instrumented spine surgery

2019 ◽  
Vol 19 (10) ◽  
pp. 1648-1656 ◽  
Author(s):  
Justin V.C. Lemans ◽  
F. Cumhur Öner ◽  
Sebastiaan P.J. Wijdicks ◽  
Miquel B. Ekkelenkamp ◽  
H. Charles Vogely ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Povidone Iodine ◽  
Surgical Site Infections ◽  
Vancomycin Powder ◽  
Instrumented Spine Surgery

scholarly journals The Association of Intraoperative Antibiotic and Surgical Site Infection After Lumbar Spine Surgery: Analysis of the Michigan Spine Surgery Improvement Collaborative

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Hesham M Zakaria ◽  
Karam P Asmaro ◽  
Tarek R Mansour ◽  
Rachel J Hunt ◽  
Theresa A Elder ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lumbar Spine ◽  
Antibiotic Prophylaxis ◽  
Spine Surgery ◽  
Private Insurance ◽  
Surgical Site Infections ◽  
Antibiotic Usage ◽  
Lumbar Spine Surgery ◽  
Perioperative Antibiotics ◽  
Vancomycin Powder

Abstract INTRODUCTION Surgical site infections (SSI) after lumbar spine surgery is costly and potentially preventable. A number of studies have shown the efficacy of vancomycin powder in preventing SSI, but there are few studies that have examined all the available perioperative antibiotics. We sought to examine associations between intraoperative antibiotic usage and SSI rates after lumbar spine surgery, as well as other risk factors for SSI, using a large prospective database. METHODS The Michigan Spine Surgery Improvement Collaborative (MSSIC) is a large multi-institute collaborative. MSSIC was queried to test the association between intraoperative antibiotic irrigation (bacitracin, cefazolin, vancomycin, etc), intraoperative vancomycin powder only, a combination of the two, and postoperative antibiotics with SSI using generalized estimating equations (GEE) models; variables included: age, gender, BMI, diabetes, heart disease, scoliosis, previous spine surgery, preoperative ambulatory status, insurance type (public vs private), surgery type (fusion vs decompression alone), and number of surgical levels. RESULTS A total of 24 229 patients undergoing lumbar spine surgery were included in the multivariate analysis. Postoperative antibiotic prophylaxis did not affect SSI (OR 1.00, P = .987). Preoperative antibiotics were universally given, and further analysis of intraoperative antibiotic usage was done. All comparisons were done to no additional antibiotics used; using only intraoperative vancomycin powder was associated with lower SSI (OR 0.77, P = .286). Using antibiotic irrigation only was associated with a significantly higher rate of SSI (OR1 .42, P = .009). Using a combination intraoperative vancomycin and irrigation was again associated with higher SSI (OR 1.28, P = .127), but not as high as irrigation alone. Protective factors for SSI include independently ambulation (OR 0.80, P = .015) and private insurance (OR 0.74, P = .001). Risk factors for SSI include BMI (OR 1.33, P < .001), diabetes (OR 1.36, P < .001), fusion (OR 1.41, P = .001), and increasing surgical levels (OR 1.59, P = .006). CONCLUSION The use of postoperative antibiotic prophylaxis was not associated with SSI. Intraoperative antibiotic irrigation may be less effective than realized, and the use of intraoperative vancomycin powder alone may be effective in preventing SSI. The efficacy of intraoperative antibiotic irrigation in preventing infection requires further investigation. Other risk factors for SSI are confirmed.

scholarly journals Risk Factors and Prevention of Surgical Site Infections Following Spinal Procedures

2018 ◽  
Vol 8 (4_suppl) ◽  
pp. 44S-48S ◽  
Author(s):  
Rani Nasser ◽  
Jennifer A. Kosty ◽  
Sanjit Shah ◽  
Jeffrey Wang ◽  
Joseph Cheng
Keyword(s):  
Risk Factors ◽  
Spine Surgery ◽  
Wound Care ◽  
Surgical Site Infections ◽  
Perioperative Period ◽  
Skin Preparation ◽  
Cochrane Database ◽  
Personnel Turnover ◽  
Potential Risk Factors ◽  
Meta Analyses

Study Design: Focused literature review. Objective: The objective of this article was to help identify potential risk factors as well as strategies to help prevent surgical site infections (SSIs) in spine surgery. Methods: An article search was performed using PubMed, EMBASE, and the Cochrane database of systematic reviews using the terms “surgery” OR “surgical” AND “spine” OR “spinal” AND “infection”. Systematic review articles, meta-analyses, and clinical trials with more than 100 patients were reviewed. Results: Both patient and perioperative factors contribute to the development of SSIs. Patient factors such as smoking, obesity, diabetes, Methicillin-resistant Staphylococcus aureus (MRSA) colonization, and malnutrition are all modifiable risk factors that can lead to SSIs. Procedural steps, including preoperative MRSA screening and treatment for colonization, preoperative antibiotics, skin preparation, minimizing operative time, antibiotic or betadine irrigation, avoiding personnel turnover, and postoperative wound care have also been shown to decrease infection rates. Conclusion: There are several measures a spine practitioner may be able to take in the preoperative, intraoperative, and postoperative settings. Protocols to counsel patients regarding modification of preexisting risk factors and ensure adequate antimicrobial therapy in the perioperative period may be developed to reduce SSIs in spine surgery.

Is Intraoperative Local Vancomycin Powder the Answer to Surgical Site Infections in Spine Surgery?

Spine ◽  
2017 ◽  
Vol 42 (4) ◽  
pp. 267-274 ◽  
Author(s):  
Hwee Weng Dennis Hey ◽  
Desmond Wei Thiam ◽  
Zhi Seng Darren Koh ◽  
Joseph Shantakumar Thambiah ◽  
Naresh Kumar ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Surgical Site Infections ◽  
Vancomycin Powder

scholarly journals The effect of prophylactic vancomycin powder on infections following spinal surgeries: a systematic review

2019 ◽  
Vol 46 (1) ◽  
pp. E11 ◽  
Author(s):  
Vincent Dodson ◽  
Neil Majmundar ◽  
Vanessa Swantic ◽  
Rachid Assina
Keyword(s):  
Systematic Review ◽  
Spine Surgery ◽  
Surgical Site Infections ◽  
Control Group ◽  
Control Groups ◽  
Gram Negative ◽  
Number Of Patients ◽  
Vancomycin Powder ◽  
Meta Analyses ◽  
Experimental Group

OBJECTIVEThe use of vancomycin powder in spine surgery for prophylaxis against surgical site infections (SSIs) is well debated in the literature, with the majority of studies demonstrating improvement and some studies demonstrating no significant reduction in infection rate. It is well known in certain populations that vancomycin powder reduces the general rate of infection, but its effects on reducing the rate of infection due to gram-negative pathogens are not well reviewed. The goal of this paper was to review studies that investigated the efficacy of vancomycin powder as a prophylactic agent against SSI and demonstrate whether the rate of infections by gram-negative pathogens is impacted.METHODSAn electronic search of the published literature was performed using PubMed and Google Scholar in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A variety of combinations of the search terms “vancomycin powder,” “infection,” “spine,” “gram-negative,” “prophylaxis,” and “surgical site” was used. Inclusion criteria were studies that 1) described an experimental group that received intraoperative intrawound vancomycin powder; 2) included adequately controlled groups that did not receive intraoperative intrawound vancomycin powder; 3) included the number of patients in both the experimental and control groups who developed infection after their spine surgery; and 4) identified the pathogen-causing infection. Studies not directly related to this review’s investigation were excluded from the initial screen. Among the studies that met the criteria of the initial screen, additional reasons for exclusion from the systematic review included lack of a control group, unspecified size of control groups, and inconsistent use of vancomycin powder in the experimental group.RESULTSThis systematic review includes 21 studies with control groups. Vancomycin powder significantly reduced the relative risk of developing an SSI (RR 0.55, 95% CI 0.45–0.67, p < 0.0001). In addition, the use of vancomycin powder did not significantly increase the risk of infection by gram-negative pathogens (RR 1.11, 95% CI 0.66–1.86, p = 0.701).CONCLUSIONSThe results of this systematic review suggest that intrawound vancomycin powder is protective against SSI. It is less clear if this treatment increases the risk of gram-negative infection. Further studies are required to investigate whether rates of infection due to gram-negative pathogens are affected by the use of vancomycin powder.

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