Does the Application of Topical Intrawound Vancomycin Powder Affect Deep Surgical Site Infection and the Responsible Organisms after Spinal Surgery?: A Retrospective Case Series with a Historical Control Group

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.

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Management of late-onset deep surgical site infection after instrumented spinal surgery

BMC Surgery ◽

10.1186/s12893-018-0458-4 ◽

2018 ◽

Vol 18 (1) ◽

Cited By ~ 8

Author(s):

Dong Yin ◽

Bin Liu ◽

Yunbing Chang ◽

Honglin Gu ◽

Xiaoqing Zheng

Keyword(s):

Surgical Site Infection ◽

Spinal Surgery ◽

Late Onset ◽

Site Infection ◽

Deep Surgical Site Infection

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Application of an index derived from the area under a neutrophil curve as a predictor of surgical site infection after spinal surgery

BMC Surgery ◽

10.1186/s12893-021-01345-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hiroyuki Inose ◽

Yutaka Kobayashi ◽

Shingo Morishita ◽

Yu Matsukura ◽

Masato Yuasa ◽

...

Keyword(s):

Surgical Site Infection ◽

Sensitivity And Specificity ◽

Spinal Surgery ◽

Operating Characteristic ◽

Characteristic Curve ◽

Objective Assessment ◽

Cutoff Point ◽

Control Group ◽

Site Infection ◽

Neutrophil Percentage

Abstract Background Patients with prolonged and intense neutrophilia after spinal surgery are at high risk of developing surgical site infection (SSI). To date, there is no standard method for the objective assessment of the intensity and duration of neutrophilia. Thus, this retrospective observational study aimed to test a new index (I-index), developed by combining the duration and intensity of neutrophilia, as a predictor of SSI. Methods I-index was calculated based on the postoperative neutrophil percentage. A total of 17 patients with SSI were enrolled as cases, and 51 patients without SSI were selected as controls. The groups were matched at a ratio of 1:3 by age, sex, and surgery type. The differences in the I-index were compared between the groups. Moreover, we checked the cumulative I-index (c-I-index), which we defined as the area under the neutrophil curve from postoperative day 1 until the first clinical manifestation of SSI in each case. Furthermore, a cutoff for SSI was defined using the receiver operating characteristic curve. Results The median I-index-7, I-index-14, and c-I-index were significantly higher in the SSI group than those in the control group. For a cutoff point of 42.1 of the I-index-7, the sensitivity and specificity were 0.706 and 0.882, respectively. For a cutoff point of 45.95 of the I-index-14, the sensitivity and specificity were 0.824 and 0.804, respectively. For a cutoff point of 45.95 of the c-I-index, the sensitivity and specificity were 0.824 and 0.804, respectively. Conclusion We devised a new indicator of infection, i.e., the I-Index and c-I-index, and confirmed its usefulness in predicting SSI.

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

Pakistan Journal Of Neurological Surgery ◽

10.36552/pjns.v23i3.351 ◽

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.

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Factors Associated with Deep Surgical Site Infection Following Spinal Surgery: A Pilot Study

Cureus ◽

10.7759/cureus.4377 ◽

2019 ◽

Author(s):

Ed S Khan ◽

Ren Yi Kow ◽

Khairul Bariyyah Binti M Arifin ◽

Colin Komahen ◽

Chooi Leng Low ◽

...

Keyword(s):

Pilot Study ◽

Surgical Site Infection ◽

Spinal Surgery ◽

Site Infection ◽

Factors Associated ◽

Deep Surgical Site Infection

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A retrospective case series study of a single centre's experience of surgical site infection following purse-string closure versus linear closure of ileostomy sites

International Journal of Surgery ◽

10.1016/j.ijsu.2012.06.141 ◽

2012 ◽

Vol 10 (8) ◽

pp. S26-S27

Author(s):

Henna Rafique

Keyword(s):

Surgical Site Infection ◽

Case Series ◽

Site Infection ◽

Retrospective Case ◽

Purse String ◽

Retrospective Case Series ◽

Case Series Study ◽

Closure Of Ileostomy ◽

Series Study

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Perioperative risk factors for surgical site infection in tibial tuberosity advancement: 224 stifles

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.3415/vcot-14-09-0141 ◽

2015 ◽

Vol 28 (03) ◽

pp. 199-206 ◽

Cited By ~ 13

Author(s):

F. W. Yap ◽

K.D. Smith ◽

T. Parkin ◽

I. Calvo

Keyword(s):

Risk Factors ◽

Surgical Site Infection ◽

Antimicrobial Therapy ◽

Significant Risk ◽

Case Series ◽

Tibial Tuberosity ◽

Sample Population ◽

Site Infection ◽

Retrospective Case ◽

Surgical Time

SummaryObjective: To examine perioperative factors affecting surgical site infection (SSI) rate following tibial tuberosity advancement (TTA).Study design: Retrospective case series.Sample population: 224 stifles in 186 dogs.Methods: Medical records of dogs that underwent TTA in a single institution were reviewed. Information on signalment anaesthetic and surgical parameters, as well as occurrence of SSI was recorded. Dogs were followed for a minimum of three months postoperatively. The association between perioperative factors and SSI was assessed usingChi-squared tests and binary logistic regression.Results: The prevalence of SSI was 5.3% (12/224 TTA). Surgical time (p = 0.02) and anaesthesia time (p = 0.03) were significantly associated with SSI. For every minute increase in surgical time and anaesthesia time, the likelihood of developing SSI increased by seven percent and four percent respectively. The use of postoperative antimicrobial therapy was not significantly associated with lower SSI (p = 0.719). Implants were removed in 1.3% of cases (3/224 TTA).Conclusions: The findings of this study suggest that increased surgical and anaesthesia times are significant risk factors for SSI in TTA, and that there is no evidence that postoperative prophylactic antimicrobial therapy is associated with SSI rate.

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