SLR - June 2017 - Harshil Patel
Reference: Schroeder JE, Girardi FP, Sandhu H, Weinstein J, Cammisa FP, Sama A. The Use of Local Vancomycin Powder in Degenerative Spine Surgery. Eur Spine J. 2016 Apr;25(4):1029–33.Reviewed By: Harshil Patel
Residency Program: Bethesda Hospital East, Boynton Beach, FL
Podiatric Relevance: Surgical site infection postoperatively is one of the most common complications with podiatric surgery. Currently, surgical guidelines recommend perioperative prophylaxis with systemic antibiotics to reduce the risk of postoperative surgical site infections. Administration of intrawound antibiotics may have the potential to provide high intrawound concentrations without the risk of systemic toxicity, especially in those patients with comorbidities. This study reviews reduction in deep infection rates in spine surgery by application of local vancomycin powder into surgical wounds prior to closure.
Methods: A retrospective study was performed comparing deep infection rates in spine surgery of patients who were treated with local vancomycin powder and without intraoperative local vancomycin powder. A total of 3,477 cases were reviewed, of which 1,224 were performed with the use of local vancomycin powder and 2,253 cases were performed without the use of local vancomycin powder. All patients underwent spine surgery by one of four spine surgeons at an orthopaedic center. Patients’ charts and microbiology reports were reviewed to determine whether or not local vancomycin powder was used and whether or not patients had postoperative infection.
Results: There was a statistically significant decrease in deep infection after spine surgery in those patients who were administered local vancomycin powder in comparison to those patient who did not have local vancomycin powder (P = 0.04). Out of 2,253 cases where local vancomycin powder was not used, 30 cases needed surgical irrigation and debridement (1.3 percent). Out of 1,224 cases where local vancomycin powder was used, only five cases needed surgical irrigation and debridement (0.41 percent).
Conclusions: Local administration of vancomycin powder is statistically significant for reducing the rate of deep wound infection after spine surgery. These findings are consistent with the hypothesis that administration of intrawound antibiotics may have the potential to provide high intrawound concentrations and to reduce the risk of surgical site infections in podiatric surgery.