The effectiveness of local application of vancomycin powder in the prevention of surgical site infections in spine surgery: a meta-analysis

2020 ◽  
pp. 60
Author(s):  
I.A. STEPANOV ◽  
V.A. BELOBORODOV ◽  
V.E. BORISOV ◽  
M.A. ALIEV ◽  
V.V. SHEPELEV ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Meta Analysis ◽  
Surgical Site Infections ◽  
Local Application ◽  
Vancomycin Powder

scholarly journals A meta-analysis of the local application of vancomycin powder to prevent surgical site infection after spinal surgeries

2020 ◽  
Vol 48 (7) ◽  
pp. 030006052092005
Author(s):  
Shuo Shan ◽  
Laiyong Tu ◽  
Wenfei Gu ◽  
Kahaer Aikenmu ◽  
Jiang Zhao
Keyword(s):  
Surgical Site Infection ◽  
Meta Analysis ◽  
Local Application ◽  
Site Infection ◽  
China National Knowledge Infrastructure ◽  
Knowledge Infrastructure ◽  
Mesh Terms ◽  
Vancomycin Powder ◽  
Vancomycin Group ◽  
And Control

Objective This study aimed to systematically analyze the effectiveness and safety of the local application of vancomycin powder to prevent surgical site infection (SSI) after spinal surgeries and provide guidance for clinical practice. Methods Two researchers independently searched PubMed, Web of Science, Elsevier, and China National Knowledge Infrastructure using the MeSH terms “spinal surgery,” “vancomycin,” “local,” “topical,” “prophylactic,” “surgical site infection,” and “SSI” to identify studies published between January 2010 and January 2020 on the local application of vancomycin powder for preventing SSI after spinal surgeries. The outcome assessment indicators were analyzed using RevMan 5.3 software. Results Three randomized controlled trials, two prospective studies, and 26 retrospective studies were included in the current research. The results of the meta-analysis revealed significant differences between the vancomycin and control groups (non-vancomycin group) concerning the incidence of SSI (risk ratio = 0.39, 95% confidence interval = 0.28–0.55, Z = 5.46), indicating that local application of vancomycin powder can significantly reduce the incidence of SSI. Conclusion Local application of vancomycin powder is an effective and safe method to prevent SSI after spinal surgeries.

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.

A meta-analysis of spinal surgical site infection and vancomycin powder

2014 ◽  
Vol 21 (6) ◽  
pp. 974-983 ◽  
Author(s):  
Nickalus R. Khan ◽  
Clinton J. Thompson ◽  
Michael DeCuypere ◽  
Jonathan M. Angotti ◽  
Erick Kalobwe ◽  
...  
Keyword(s):  
Relative Risk ◽  
Surgical Site Infection ◽  
Risk Reduction ◽  
Spine Surgery ◽  
Spinal Surgery ◽  
Meta Analysis ◽  
Control Group ◽  
Number Needed To Treat ◽  
Site Infection ◽  
Vancomycin Powder

Object Surgical site infection (SSI) is a serious and costly complication of spinal surgery. There have been several conflicting reports on the use of intrawound vancomycin powder in decreasing SSI in spine surgery. The purpose of this study is to answer the question: “Does intrawound vancomycin powder reduce the rate of SSIs in spine surgery?” Methods A comprehensive search of multiple electronic databases and bibliographies was conducted to identify clinical studies that evaluated the rates of SSI with and without the use of intrawound vancomycin powder in spine surgery. Independent reviewers extracted data and graded the quality of each paper that met inclusion criteria. A random effects meta-analysis was then performed. Results The search identified 9 retrospective cohort studies (Level III evidence) and 1 randomized controlled trial (Level II evidence). There were 2574 cases and 106 infections in the control group (4.1%) and 2518 cases and 33 infections (1.3%) in the treatment group, yielding a pooled absolute risk reduction and relative risk reduction of 2.8% and 68%, respectively. The meta-analysis revealed the use of vancomycin powder to be protective in preventing SSI (relative risk = 0.34, 95% confidence interval 0.17–0.66, p = 0.021). The number needed to treat to prevent 1 SSI was 36. A subgroup analysis found that patients who had implants had a reduced risk of SSI with vancomycin powder (p = 0.023), compared with those who had noninstrumented spinal operations (p = 0.226). Conclusions This meta-analysis suggests that the use of vancomycin powder may be protective against SSI in open spinal surgery; however, the exact population in which it should be used is not clear. This benefit may be most appreciated in higher-risk populations or in facilities with a high baseline rate of infection.

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

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 Intrawound Treatment for Prevention of Surgical Site Infections in Instrumented Spinal Surgery: A Systematic Comparative Effectiveness Review and Meta-Analysis

2018 ◽  
Vol 9 (2) ◽  
pp. 219-230 ◽  
Author(s):  
Justin V. C. Lemans ◽  
Sebastiaan P. J. Wijdicks ◽  
Willemijn Boot ◽  
Geertje A. M. Govaert ◽  
R. Marijn Houwert ◽  
...  
Keyword(s):  
Relative Risk ◽  
Randomized Controlled Trials ◽  
Spine Surgery ◽  
Spinal Surgery ◽  
Meta Analysis ◽  
Surgical Site Infections ◽  
Controlled Trials ◽  
Local Antibiotics ◽  
Randomized Controlled ◽  
Instrumented Spine Surgery

Study Design: Systematic review and meta-analysis. Objectives: To determine the efficacy of intrawound treatments in reducing deep surgical site infections (SSIs) in instrumented spinal surgery. Methods: The electronic databases MEDLINE, EMBASE, and Cochrane were systematically searched for intrawound treatments for the prevention of SSIs in clean instrumented spine surgery. Both randomized controlled trials and comparative cohort studies were included. The results of included studies were pooled for meta-analysis. Results: After full text- and reference screening, 20 articles were included. There were 2 randomized controlled trials and 18 observational studies. Sixteen studies investigated the use of intrawound antibiotics, and 4 studies investigated the use of intrawound antiseptics. The relative risk of deep SSI for any treatment was 0.26 (95% confidence interval [CI] 0.16-0.44, P < .0001), a significant reduction compared with controls receiving no treatment. For patients treated with local antibiotics the relative risk was 0.29 (95% CI 0.17-0.51, P < .0001), and patients treated with local antiseptics had a relative risk of 0.14 (95% CI 0.05-0.44, P = .0006). Conclusions: Both the use of antibiotic and antiseptic intrawound prophylactics was associated with a significant 3 to 7 times reduction of deep SSIs in instrumented spine surgery. No adverse events were reported in the included studies.

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