Intrawound Low-dose Vancomycin (250 mg) Powder has Lower Risk of Wound Dehiscence than Higher Doses in Spine Surgeries

2021 ◽  
pp. 46
Author(s):  
Ahmed Sonbol
Keyword(s):  
Surgical Site Infection ◽  
Low Dose ◽  
Wound Dehiscence ◽  
High Dose ◽  
Site Infection ◽  
Systemic Complications ◽  
Significant Difference ◽  
Vancomycin Powder ◽  
Vancomycin Group ◽  
Higher Doses

Introduction: Surgical site infection post spinal surgery is a known complication which can be serious and may require aggressive intervention. Intrawound vancomycin powder application is an evolving method to prevent such complication. Although it has very low systemic complications, wound dehiscence with negative culture is reported in the literature. The aim of this study was to find the risk of wound dehiscence with low-dose intrawound vancomycin in comparison to 1 gr and its effectiveness in prevention of surgical site infection. Methodology: A chart review of all patients who underwent posterior thoracic, lumbar or sacral spine surgeries from December 2009 to September 2016 in a single center was done. Patients were categorized into three groups. First, patients who did not receive any intrawound vancomycin; second, patients who received high-dose vancomycin (1 gr); and third, patients who received low-dose vancomycin (250 mg). Additionally, patients’ demographic information, clinical data, and surgical variables were collected. Primary outcome was the presence of wound dehiscence or surgical site infection. Result: In total, 391 patients were included in this study, of which 56 (14.3%) received high-dose intrawound vancomycin, 126 (32.2%) received low dose, and 209 (53.5%) did not receive any. The overall incidence of wound dehiscence was 6.14% (24 out of 391 patients). Wound dehiscence was statistically and significantly higher (p = 0.039) in the high-dose vancomycin group in comparison to the patients who received low dose. The overall incidence of postoperative infection was 2.05% (eight patients). There was no statistically significant difference between the groups. Conclusion: The use of intrawound low-dose vancomycin (250 mg) has less wound dehiscence in comparison with other higher standard doses. Further trials are needed to evaluate the effectiveness of this dose in preventing postoperative infections.

scholarly journals Prophylaxis of Surgical Site Infection in Cranial Surgery with Vancomycin Powder Application into Wound

2019 ◽  
Vol 23 (3) ◽  
pp. 205-210
Author(s):  
SAMI UR REHMAN ◽  
RIFFAT ULLAH KHAN ◽  
GHAYUR ABBAS ◽  
USAMA BIN ZUBAIR ◽  
KAMRAN KHAN ◽  
...  
Keyword(s):  
Treatment Group ◽  
Surgical Site Infection ◽  
Control Group ◽  
P Value ◽  
Site Infection ◽  
Significant Difference ◽  
Routine Prophylaxis ◽  
Vancomycin Powder ◽  
Vancomycin Group ◽  
Lost To Follow Up

Objective: To see the effect of application of Vancomycin powder directly into the subgaleal space in reducing the postoperative surgical site infections.Materials and Methods: All the patients who underwent consecutive elective craniotomies from April 2017 to May 2018 Dept of Neurosurgery, szabmu, PIMS, Islamabad. The control group received the standard routine prophylaxis according to the hospital protocols, whereas the treatment group, in addition to the standard prophylaxis, received Vancomycin powder in the surgical wound in addition to the standard routine prophylaxis. Results: 182 patients were enrolled in the study, 91 allocated to each the control and treatment group (Vancomycin). Six patients were lost to follow up. There were 90 patients in the control group and 86 patients in the treatment (Vancomycin) group. Both the groups were almost statistically similar. In the control group, 34.09% (n = 60) were male and 17.04% (n = 30) were female. In the treatment group, 29.54% (n = 52) were male and 19.31% (n = 34) were female. The overall rate of surgical site infection (SSI) was 3.97% (7 out of 176 cases). A statistically significant difference found in infection rate between the treatment group, 0% (0 out of 86 cases) and the control group, 7.77% (7 out of 90 cases) with the p value of 0.002. Conclusions: The use of topical Vancomycin powder in surgical wounds may significantly reduce the incidence of infection in patients undergoing elective craniotomies. It is a promising means of preventing devastating and harmful postoperative wound infections.

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.

The impact of low-dose versus high-dose antibiotic prophylaxis regimens on surgical site infection rates after cesarean delivery

2019 ◽  
Vol 301 (1) ◽  
pp. 69-73 ◽  
Author(s):  
Mauricio La Rosa ◽  
Chasey Omere ◽  
Tiffany Redfern ◽  
Mahmoud Abdelwahab ◽  
Nicholas Spencer ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Antibiotic Prophylaxis ◽  
Cesarean Delivery ◽  
Low Dose ◽  
High Dose ◽  
Site Infection ◽  
Infection Rates ◽  
The Impact

scholarly journals 411: The impact of low dose versus high dose antibiotic prophylaxis regimens on surgical site infection rates after cesarean delivery

2017 ◽  
Vol 216 (1) ◽  
pp. S244-S245
Author(s):  
Mauricio La Rosa ◽  
Chasey Omere ◽  
Tiffany Redfurn ◽  
Mahmoud Abdelwahab ◽  
Nicholas Spencer ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Antibiotic Prophylaxis ◽  
Cesarean Delivery ◽  
Low Dose ◽  
High Dose ◽  
Site Infection ◽  
Infection Rates ◽  
The Impact

scholarly journals Biodosimetry of Low Dose Ionizing Radiation Using DNA Repair Foci in Human Lymphocytes

Genes ◽  
2020 ◽  
Vol 11 (1) ◽  
pp. 58 ◽  
Author(s):  
Lukáš Jakl ◽  
Eva Marková ◽  
Lucia Koláriková ◽  
Igor Belyaev
Keyword(s):  
Dna Repair ◽  
Ionizing Radiation ◽  
Low Dose ◽  
Time Window ◽  
Human Lymphocytes ◽  
High Dose ◽  
Low Doses ◽  
Significant Difference ◽  
Kinetics Of ◽  
Higher Doses

Purpose: Ionizing radiation induced foci (IRIF) known also as DNA repair foci represent most sensitive endpoint for assessing DNA double strand breaks (DSB). IRIF are usually visualized and enumerated with the aid of fluorescence microscopy using antibodies to γH2AX and 53BP1. This study analyzed effect of low dose ionizing radiation on residual IRIF in human lymphocytes to the aim of potential biodosimetry and possible extrapolation of high-dose γH2AX/53BP1 effects to low doses and compared kinetics of DSB and IRIF. We also analyzed whether DNaseI, which is used for reducing of clumps, affects the IRIF level. Materials and Methods: The cryopreserved human lymphocytes from umbilical cord blood (UCB) were thawed with/without DNaseI, γ-irradiated at doses of 0, 5, 10, and 50 cGy and γH2AX/53BP1 foci were analyzed 30 min, 2 h, and 22 h post-irradiation using appropriate antibodies. We also analyzed kinetics of DSB using PFGE. Results: No significant difference was observed between data obtained by γH2AX foci evaluation in cells that were irradiated by low doses and data obtained by extrapolation from higher doses. Residual 53BP1 foci induced by low doses significantly outreached the data extrapolated from irradiation by higher doses. 53BP1 foci induced by low dose-radiation remain longer at DSB loci than foci induced by higher doses. There was no significant effect of DNaseI on DNA repair foci. Conclusions: Primary γH2AX, 53BP1 foci and their co-localization represent valuable markers for biodosimetry of low doses, but their usefulness is limited by short time window. Residual γH2AX and 53BP1 foci are more useful markers for biodosimetry in vitro. Effects of low doses can be extrapolated from high dose using γH2AX residual foci while γH2AX/53BP1 foci are valuable markers for evaluation of initial DSB induced by ionizing radiation. Residual IRIF induced by low doses persist longer time than those induced by higher doses.

scholarly journals Effect of intrasite vancomycin powder on development of epidural fibrosis

2018 ◽  
Vol 10 (4) ◽  
Author(s):  
Benjamin Clippinger ◽  
Mark Ayzenberg ◽  
Michael Narvaez ◽  
Dillon Arango ◽  
Corrado Minimo ◽  
...  
Keyword(s):  
Low Dose ◽  
Control Group ◽  
High Dose ◽  
Epidural Fibrosis ◽  
Vancomycin Powder ◽  
Group A ◽  
Grade 3 ◽  
Vancomycin Group ◽  
And Control ◽  
Closure Group

Placement of vancomycin powder into the surgical wound prior to closure has been shown to reduce postoperative infections in spine surgery. This study examines the effect of vancomycin powder on formation of epidural fibrosis (EF). Twenty-two rats underwent a two-level lumbar laminectomy. A control group, a low-dose and a high dose vancomycin powder (applied prior to closure) group was formed. Rats were sacrificed at 30 days and a blinded fellowshiptrained pathologist evaluated the laminectomy segments for EF. 50% of the samples in the high-dose vancomycin group were EF grade 3, compared to 20% of the low-dose and 16.7% of control samples. The average fibrosis grade for the high dose, low dose and control groups were 2.4, 1.4 and 1.8, respectively. There were more grade 3 EF specimens in the high dose vancomycin group. While the average EF grade was also higher in this group, there was not a statistical difference compared with the other groups.

scholarly journals P107 PREVENTION OF INCISIONAL HERNIA AFTER MIDLINE LAPAROTOMY WITH MODIFICATION OF CLOSURE TECHNIQUE: SYSTEMATIC REVIEW AND META ANALYSIS

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Edgard Efren Lozada Hernandez ◽  
Juan Pablo Hernandez Bonilla ◽  
Enrique Obregon Moreno ◽  
Diego Hinojosa Ugarte ◽  
Aldo Jimenez Herevia ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Incisional Hernia ◽  
Surgical Site Infection ◽  
Meta Analysis ◽  
Wound Dehiscence ◽  
Site Infection ◽  
Closure Technique ◽  
Midline Laparotomy ◽  
Significant Difference

Abstract Aim “Incisional hernia is the main complication after laparotomy, the prevention of this is currently aimed at preoperative rehabilitation, modification of the closure technique and the use of prophylactic mesh. The objective of the study was to measure the effectiveness of the modification in the laparotomy closure technique to reduce the incidence of incisional hernia.” Material and Methods “A systematic review and meta-analysis were carried out following the PRISMA guidelines. The first objective was to determine the incidence of incisional hernia at one year of follow-up, comparing the modification in the closure technique with the usual closure. The secondary objective was to determine the difference in wound dehiscence and surgical site infection between these two groups. Only clinical trials were included, and the random effects method was used for their analysis. PROSPERO registration number: CRD42021231107” Results “Seven clinical trials were included, comparing 1612 patients, the incidence of incisional hernia was significantly lower in the surgical technique modification group OR 0.55 (95% CI 0.38-79). Efficacy to reduce the incidence of wound dehiscence was also analyzed without finding a difference between the two groups OR 0.58 (95% CI 0.27-1.21). There was no statistically significant difference between both groups when comparing seroma hematoma and surgical site infection.” Conclusions “The modification in the laparotomy closure technique reduces the incidence of incisional hernia. However, when analyzing globally, only the Small bites and Reinforced tension line techniques contributed to this result.”

scholarly journals PREVENTION OF INCISIONAL HERNIA AFTER MIDLINE LAPAROTOMY WITH MODIFICATION OF CLOSURE TECHNIQUE: SYSTEMATIC REVIEW AND META ANALYSIS

2021 ◽  
Vol 108 (Supplement_3) ◽  
Author(s):  
E E Lozada Hernández ◽  
J P Hernández Bonilla ◽  
D Hinojosa Ugarte
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Incisional Hernia ◽  
Surgical Site Infection ◽  
Meta Analysis ◽  
Wound Dehiscence ◽  
Site Infection ◽  
Closure Technique ◽  
Midline Laparotomy ◽  
Significant Difference

Abstract INTRODUCTION Incisional hernia is the main complication after laparotomy, the prevention of this is currently aimed at preoperative rehabilitation, modification of the closure technique and the use of prophylactic mesh. The objective of the study was to measure the effectiveness of the modification in the laparotomy closure technique to reduce the incidence of incisional hernia. MATERIAL AND METHODS. A systematic review and meta-analysis were carried out following the PRISMA guidelines. The first objective was to determine the incidence of incisional hernia at one year of follow-up, comparing the modification in the closure technique with the usual closure. The secondary objective was to determine the difference in wound dehiscence and surgical site infection between these two groups. Only clinical trials were included and the random effects method was used for their analysis. RESULTS Seven clinical trials were included, comparing 1612 patients, the incidence of incisional hernia was significantly lower in the surgical technique modification group OR 0.55 (95% CI 0.38-79). Efficacy to reduce the incidence of wound dehiscence was also analyzed without finding a difference between the two groups OR 0.58 (95% CI 0.27-1.21). There was no statistically significant difference between both groups when comparing seroma hematoma and surgical site infection. CONCLUSIONS The modification in the laparotomy closure technique reduces the incidence of incisional hernia. However, when analyzing globally, only the Small bites and Reinforced tension line techniques contributed to this result.

Clinical outcome of V-Y flap with latissimus dorsi and gluteal advancement for treatment of large thoracolumbar myelomeningocele defects: a comparative study

2019 ◽  
Vol 24 (1) ◽  
pp. 75-84
Author(s):  
Mohammad Sadegh Masoudi ◽  
Mohammad Ali Hoghoughi ◽  
Fariborz Ghaffarpasand ◽  
Shekoofeh Yaghmaei ◽  
Maryam Azadegan ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Comparative Study ◽  
Surgical Site Infection ◽  
Latissimus Dorsi ◽  
Primary Closure ◽  
Wound Dehiscence ◽  
Site Infection ◽  
Gluteal Muscle ◽  
Operative Duration ◽  
Csf Leakage

OBJECTIVESurgical repair and closure of myelomeningocele (MMC) defects are important and vital, as the mortality rate is as high as 65%–70% in untreated patients. Closure of large MMC defects is challenging for pediatric neurosurgeons and plastic surgeons. The aim of the current study is to report the operative characteristics and outcome of a series of Iranian patients with large MMC defects utilizing the V-Y flap and with latissimus dorsi or gluteal muscle advancement.METHODSThis comparative study was conducted during a 4-year period from September 2013 to October 2017 in the pediatric neurosurgery department of Shiraz Namazi Hospital, Southern Iran. The authors included 24 patients with large MMC defects who underwent surgery utilizing the bilateral V-Y flap and latissimus dorsi and gluteal muscle advancement. They also retrospectively included 19 patients with similar age, sex, and defect size who underwent surgery using the primary or delayed closure techniques at their center. At least 2 years of follow-up was conducted. The frequency of leakage, necrosis, dehiscence, systemic infection (sepsis, pneumonia), need for ventriculoperitoneal shunt insertion, and mortality was compared between the 2 groups.RESULTSThe bilateral V-Y flap with muscle advancement was associated with a significantly longer operative duration (p < 0.001) than the primary closure group. Those undergoing bilateral V-Y flaps with muscle advancement had significantly lower rates of surgical site infection (p = 0.038), wound dehiscence (p = 0.013), and postoperative CSF leakage (p = 0.030) than those undergoing primary repair. The bilateral V-Y flap with muscle advancement was also associated with a lower mortality rate (p = 0.038; OR 5.09 [95% CI 1.12–23.1]) than primary closure. In patients undergoing bilateral V-Y flap and muscle advancement, a longer operative duration was significantly associated with mortality (p = 0.008). In addition, surgical site infection (p = 0.032), wound dehiscence (p = 0.011), and postoperative leakage (p = 0.011) were predictors of mortality. Neonatal sepsis (p = 0.002) and postoperative NEC (p = 0.011) were among other predictors of mortality in this group.CONCLUSIONSThe bilateral V-Y flap with latissimus dorsi or gluteal advancement is a safe and effective surgical approach for covering large MMC defects and is associated with lower rates of surgical site infection, dehiscence, CSF leakage, and mortality. Further studies are required to elucidate the long-term outcomes.

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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