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European Spine Journal

Erschienen in:

14.09.2019 | Review Article

Meta-analysis of topical vancomycin powder for microbial profile in spinal surgical site infections

verfasst von: Sipeng Li, Hongtao Rong, Xueqin Zhang, Zhengshan Zhang, Chao Wang, Rui Tan, Yi Wang, Ting Zheng, Tao Zhu

Erschienen in: European Spine Journal | Ausgabe 12/2019

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Abstract

Objectives

To systematically evaluate the impact of topical vancomycin powder for microbial profile in spinal surgical site infections.

Methods

All available literature regarding the topical use of vancomycin powder to prevent postoperative spinal infections was retrieved from the MEDLINE, EMBASE, and Cochrane databases starting from the creation date and up until September 30, 2018.

Results

A total of 21 studies involving 15,548 patients were reviewed. The combined odds ratio showed that topical use of vancomycin powder was effective for reducing the incidence of gram-positive bacterial infections in spinal surgical sites (OR 0.41, P < 0.00001) without affecting its efficacy in the prevention of polymicrobial infections (OR 0.30, P = 0.03). Additionally, it could significantly reduce the infection rate of methicillin-resistant staphylococcus (OR 0.34, P < 0.0001). However, topical vancomycin powder showed no advantage for preventing gram-negative bacterial infections (OR 0.94, P = 0.75).

Conclusions

Topical administration of vancomycin powder may not increase the rates of gram-negative bacterial or polymicrobial infections in spinal surgical sites. On the contrary, it can significantly reduce the infection rates of gram-positive bacteria, methicillin-resistant staphylococcus (MRS) and microorganism. Of course, the topical vancomycin powder cannot change the rates of gram-negative bacterial infections, which may be related to the antimicrobial spectrum of vancomycin. Due to the limited number of articles included in this study, additional large-scale and high-quality studies are needed to provide more reliable clinical evidence.

Graphic abstract

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Magill SS, Edwards JR, Bamberg W, Beldavs ZG et al (2014) Multistate point-prevalence survey of health care-associated infections. N Engl J Med 370(13):1198–1208CrossRef

Rattan R, Parreco J, Zakrison TL, Yeh DD, Lieberman HM, Namias N (2017) Same-hospital re-admission rate is not reliable for measuring post-operative infection-related re-admission. Surg Infect (Larchmt) 18(8):904–909CrossRef

Watters WC 3rd, Baisden J, Bono CM, Heggeness MH et al (2009) Antibiotic prophylaxis in spine surgery: an evidence-based clinical guideline for the use of prophylactic antibiotics in spine surgery. Spine J 9(2):142–146CrossRef

Radcliff KE, Neusner AD, Millhouse PW, Harrop JD et al (2015) What is new in the diagnosis and prevention of spine surgical site infections. Spine J 15(2):336–347CrossRef

Smith JS, Shaffrey CI, Sansur CA, Berven SH, et al. (2011) Rates of infection after spine surgery based on 108,419 procedures: a report from the Scoliosis Research Society Morbidity and Mortality Committee. Spine (Phila Pa 1976) 36(7):556–563CrossRef

Sweet FA, Roh M, Sliva C (2011) Intrawound application of vancomycin for prophylaxis in instrumented thoracolumbar fusions: efficacy, drug levels, and patient outcomes. Spine (Phila Pa 1976) 36(24):2084–2088CrossRef

Adogwa O, Elsamadicy AA, Sergesketter A, Vuong VD et al (2017) Prophylactic use of intraoperative vancomycin powder and postoperative infection: an analysis of microbiological patterns in 1200 consecutive surgical cases. J Neurosurg Spine 27(3):328–334CrossRef

Ghobrial GM, Thakkar V, Andrews E, Lang M, et al. (2014) Intraoperative vancomycin use in spinal surgery: single institution experience and microbial trends. Spine (Phila Pa 1976) 39(7):550–555CrossRef

Jadad AR, Moore RA, Carroll D, Jenkinson C et al (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary. Control Clin Trials 17(1):1–12CrossRef

10.

Wells GA SB ODPJ, Welch V LM The Newcastle-Ottawa Scale (NOS) for assessing the quality if nonrandomized studies in meta-analyses. https://www.ohri.ca/programs/clinical_epidemiology/oxford.htm [cited 2018 Oct 11]

11.

Hartling L, Milne A, Hamm MP, Vandermeer B et al (2013) Testing the Newcastle Ottawa Scale showed low reliability between individual reviewers. J Clin Epidemiol 66(9):982–993CrossRef

12.

Shaffer WO, Baisden JL, Fernand R, Matz PG, North American Spine Society (2013) An evidence-based clinical guideline for antibiotic prophylaxis in spine surgery. Spine J 13(10):1387–1392CrossRef

13.

Strom RG, Pacione D, Kalhorn SP, Frempong-Boadu AK (2013) Lumbar laminectomy and fusion with routine local application of vancomycin powder: decreased infection rate in instrumented and non-instrumented cases. Clin Neurol Neurosurg 115(9):1766–1769CrossRef

14.

Strom RG, Pacione D, Kalhorn SP, Frempong-Boadu AK (2013) Decreased risk of wound infection after posterior cervical fusion with routine local application of vancomycin powder. Spine (Phila Pa 1976) 38(12):991–994CrossRef

15.

Levine DP (2006) Vancomycin: a history. Clin Infect Dis 42(Suppl 1):S5–12CrossRef

16.

Moellering RC Jr (2006) Vancomycin: a 50-year reassessment. Clin Infect Dis 42(Suppl 1):S3–4CrossRef

17.

Liu C, Bayer A, Cosgrove SE, Daum RS et al (2011) Clinical practice guidelines by the infectious diseases society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children: executive summary. Clin Infect Dis 52(3):285–292CrossRef

18.

Horii C, Yamazaki T, Oka H, Azuma S et al (2018) Does intrawound vancomycin powder reduce surgical site infection after posterior instrumented spinal surgery? A propensity score-matched analysis Spine J 18(12):2205–2212PubMed

19.

Mirzashahi B, Chehrassan M, Mortazavi S (2018) Intrawound application of vancomycin changes the responsible germ in elective spine surgery without significant effect on the rate of infection: a randomized prospective study. Musculoskelet Surg 102(1):35–39PubMed

20.

Sono T, Fujibayashi S, Izeki M, Shimizu Y et al (2018) Decreased rate of surgical site infection after spinal surgery with instrumentation using bundled approach including surveillance and intrawound vancomycin application. Medicine (Baltimore) 97(34):e12010CrossRef

21.

Chotai S, Wright PW, Hale AT, Jones WA et al (2017) Does intrawound vancomycin application during spine surgery create vancomycin-resistant organism. Neurosurgery 80(5):746–753CrossRef

22.

Hey HW, Thiam DW, Koh ZS, Thambiah JS, et al. (2017) Is Intraoperative Local Vancomycin Powder the Answer to Surgical Site Infections in Spine Surgery. Spine (Phila Pa 1976) 42(4):267–274CrossRef

23.

Hida T, Ando K, Kobayashi K, Ito K et al (2017) Intrawound vancomycin powder as the prophylaxis of surgical site infection after invasive spine surgery with a high risk of infection. Nagoya J Med Sci 79(4):545–550PubMedPubMedCentral

24.

Van Hal M, Lee J, Laudermilch D, Nwasike C, Kang J (2017) Vancomycin powder regimen for prevention of surgical site infection in complex spine surgeries. Clin Spine Surg 30(8):E1062–E1065CrossRef

25.

Gaviola ML, McMillian WD, Ames SE, Endicott JA, Alston WK (2016) A retrospective study on the protective effects of topical vancomycin in patients undergoing multilevel spinal fusion. Pharmacotherapy 36(1):19–25CrossRef

26.

Schroeder JE, Girardi FP, Sandhu H, Weinstein J, Cammisa FP, Sama A (2016) The use of local vancomycin powder in degenerative spine surgery. Eur Spine J 25(4):1029–1033CrossRef

27.

Heller A, McIff TE, Lai SM, Burton DC (2015) Intrawound vancomycin powder decreases staphylococcal surgical site infections after posterior instrumented spinal arthrodesis. J Spinal Disord Tech 28(10):E584–589CrossRef

28.

Martin JR, Adogwa O, Brown CR, Kuchibhatla M et al (2015) Experience with intrawound vancomycin powder for posterior cervical fusion surgery. J Neurosurg Spine 22(1):26–33CrossRef

29.

Suh BK, Moon SH, Kim TH, Oh JK et al (2015) Efficacy of antibiotics sprayed into surgical site for prevention of the contamination in the spinal surgery. Asian Spine J 9(4):517–521CrossRef

30.

Hill BW, Emohare O, Song B, Davis R, Kang MM (2014) The use of vancomycin powder reduces surgical reoperation in posterior instrumented and noninstrumented spinal surgery. Acta Neurochir (Wien) 156(4):749–754CrossRef

31.

Martin JR, Adogwa O, Brown CR, Bagley CA, et al. (2014) Experience with intrawound vancomycin powder for spinal deformity surgery. Spine (Phila Pa 1976) 39(2):177–184CrossRef

32.

Theologis AA, Demirkiran G, Callahan M, Pekmezci M, Ames C, Deviren V (2014) Local intrawound vancomycin powder decreases the risk of surgical site infections in complex adult deformity reconstruction: a cost analysis. Spine (Phila Pa 1976) 39(22):1875–1880CrossRef

33.

Caroom C, Tullar JM, Benton EG Jr, Jones JR, Chaput CD (2013) Intrawound vancomycin powder reduces surgical site infections in posterior cervical fusion. Spine (Phila Pa 1976) 38(14):1183–1187CrossRef

34.

Kim HS, Lee SG, Kim WK, Park CW, Son S (2013) Prophylactic intrawound application of vancomycin powder in instrumented spinal fusion surgery. Korean J Spine 10(3):121–125CrossRef

35.

Tubaki VR, Rajasekaran S, Shetty AP (2013) Effects of using intravenous antibiotic only versus local intrawound vancomycin antibiotic powder application in addition to intravenous antibiotics on postoperative infection in spine surgery in 907 patients. Spine (Phila Pa 1976) 38(25):2149–2155CrossRef

36.

O'Neill KR, Smith JG, Abtahi AM, Archer KR et al (2011) Reduced surgical site infections in patients undergoing posterior spinal stabilization of traumatic injuries using vancomycin powder. Spine J 11(7):641–646CrossRef

Titel: Meta-analysis of topical vancomycin powder for microbial profile in spinal surgical site infections
verfasst von: Sipeng Li
Hongtao Rong
Xueqin Zhang
Zhengshan Zhang
Chao Wang
Rui Tan
Yi Wang
Ting Zheng
Tao Zhu
Publikationsdatum: 14.09.2019
Verlag: Springer Berlin Heidelberg
Erschienen in: European Spine Journal / Ausgabe 12/2019
Print ISSN: 0940-6719
Elektronische ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-019-06143-6

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Meta-analysis of topical vancomycin powder for microbial profile in spinal surgical site infections