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Órgano Oficial de Difusión Científica de la Federación Mexicana de Colegios de Ortopedia y Traumatología, A.C. (FEMECOT)

2022, Number 3

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Ortho-tips 2022; 18 (3)

Vancomycin, efficacy reflected in costs for the treatment of infection in spinal surgery

Caldera HG, Galicia ZMÁ, Recillas HRI, Cob GNE

Language: Spanish
References: 20
Page: 200-207
PDF size: 212.00 Kb.


ABSTRACT

Introduction: There is effective evidence (p < 0.05) that the intra-wound application of vancomycin in spinal surgery exerts a protective role against surgical site infection. Affected patients are related to prolonged hospitalization time and incapacity for work, lower quality of life indices and, in general, an increase in morbidity and mortality. The required treatment demands significant economic resources, derived from days of stay in the hospital, use of operating rooms, diagnostic aids, reinterventions and intravenous antibiotic therapy. This is reflected in costs ranging from $4,067 to $36,000 in various studies. Objective: To determine the efficacy of topical vancomycin in the prevention of infections at the surgical wound level in spinal surgery and its impact translated into costs, in a concentration hospital for spinal pathology care. Material and methods: Prospective, non-randomized, observational and comparative cohort study of 180 patients with instrumented surgeries of the cervical, thoracic and lumbar spine in the period between January 2019 and December 2021. In 90 cases with placement of one gram of vancomycin topical and 90 cases without it, in a non-randomized manner. All patients were followed up during the first 90 postoperative days; those who required hospitalization for infection at the level of the wound, a record of the cases was kept until the closure of the wound and discharge from the hospital. Results: The relationship between vancomycin infection was statistically significant, 10 cases of infection in the group without vancomycin against one case in the group with vancomycin; RR: 0.1, CI: 0.0131-0.7651, p = 0.0047. Infection cases that require readmission for wound site care present an average of: 8 to 20 days of hospital stay, one to six admissions to the operating room, and cases of deep infection require up to four replacements with negative pressure therapy until wound closure. In costs it translates from 39,000 to 187,592 Mexican pesos, extra to the standard spinal surgery treatment. Conclusions: Topical vancomycin exerts a protective role against the risk of infection at the surgical site in spinal surgery, RR: 0.1, CI: 0.0131-0.7651, p = 0.0047, being statistically significant (p < 0.05). The use of vancomycin in a group of 90 patients represents a saving of 915,038 pesos; against the treatment required for the care of 10 cases of infection, in the group of 90 patients without antimicrobial in the wound.


REFERENCES

  1. Melichercik P, Klapkova E, Landor I, Judl T, Sibek M, Jahoda D. The effect of vancomycin degradation products in the topical treatment of osteomyelitis. Bratisl Lek Listy. 2014; 115: 796-799.

  2. Baron JE, Shamrock AG, Cates WT, Cates RA, An Q, Wolf BR, et al. Graft preparation with intraoperative vancomycin decreases infection after ACL reconstruction: a review of 1,640 cases. J Bone Joint Surg Am. 2019; 101 (24): 2187-2193.

  3. Heckmann ND, Mayfield CK, Culvern CN, Oakes DA, Lieberman JR, Della Valle CJ. Systematic review and meta-analysis of intrawound vancomycin in total hip and total knee arthroplasty: a call for a prospective randomized trial. J Arthroplasty. 2019; 34 (8): 1815-1822.

  4. Chen AF, Fleischman A, Austin MS. Use of intrawound antibiotics in orthopaedic surgery. J Am Acad Orthop Surg. 2018; 26 (17): e371-e378.

  5. O´Toole RV, Joshi M, Carlini AR, Murray CK, Allen LE, Scharfstein DO, et al. Local antibiotic therapy to reduce infection after operative treatment of fractures at high risk of infection: a multicenter, randomized, controlled trial (VANCO Study). J Orthop Trauma. 2017; 31 Suppl 1: S18-S24.

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

  7. Alcalá-Cerra G, Paternina-Caicedo AJ, Moscote-Salazar LR, Gutiérrez-Paternina JJ, Niño-Hernández LM. Aplicación de vancomicina en polvo dentro de la herida quirúrgica durante cirugías de columna: revisión sistemática y metaanálisis. Rev Esp Cir Ortop Traumatol. 2014; 58: 182-191.

  8. Bakhsheshian J, Dahdaleh NS, Lam SK, Savage JW, Smith ZA. The use of vancomycin powder in modern spine surgery: systematic review and meta-analysis of the clinical evidence. World Neurosurg. 2015; 83 (5): 816-823.

  9. Ghobrial GM, Cadotte DW, Williams K Jr, Fehlings MG, Harrop JS. Complications from the use of intrawound vancomycin in lumbar spinal surgery: a systematic review. Neurosurg Focus. 2015; 39 (4): E11.

  10. Takahashi H, Iida Y, Yokoyama Y, Hasegawa K, Tsuge S, Fukutake K, et al. Use of intrawound vancomycin powder against postoperative infection after spine surgery. Spine Surg Relat Res. 2018; 2 (1): 18-22.

  11. Gande A, Rosinski A, Cunningham T, Bhatia N, Lee YP. Selection pressures of vancomycin powder use in spine surgery: a meta-analysis. Spine J. 2019; 19 (6): 1076-1084.

  12. Li S, Rong H, Zhang X, Zhang Z, Wang C, Tan R, et al. Meta-analysis of topical vancomycin powder for microbial profile in spinal surgical site infections. Eur Spine J. 2019; 28 (12): 2972-2980.

  13. Kunakornsawat S, Sirikajohnirun S, Piyaskulkaew C, Pruttikul P, Kittithamvongs P, Pongpinyopap W, et al. Comparison between 1 g and 2 g of intrawound vancomycin powder application for prophylaxis in posterior instrumented thoracic or lumbosacral spine surgery: a preliminary report. Asian J Neurosurg. 2019; 14 (3): 710-714.

  14. Lemans JVC, Oner FC, Wijdicks SPJ, Ekkelenkamp MB, Vogely HC, Kruyt MC. The efficacy of intrawound vancomycin powder and povidone-iodine irrigation to prevent surgical site infections in complex instrumented spine surgery. Spine J. 2019; 19 (10): 1648-1656.

  15. López HF, Sánchez CF, Gagliardi M, Guiroy A. Vancomicina tópica en la prevención de infecciones tempranas en cirugías instrumentadas espinales: serie de casos y revisión de la literatura. Rev Argent Neuroc. 2018; 32: 158-164.

  16. Emohare O, Ledonio CG, Hill BW, Davis RA, Polly DW Jr, Kang MM. Cost savings analysis of intrawound vancomycin powder in posterior spinal surgery. Spine J. 2014; 14 (11): 2710-2715.

  17. Boody BS, Jenkins TJ, Hashmi SZ, Hsu WK, Patel AA, Savage JW. Surgical Site Infections in Spinal Surgery. J Spinal Disord Tech. 2015; 28 (10): 352-362.

  18. Kuhns BD, Lubelski D, Alvin MD, Taub JS, McGirt MJ, Benzel EC, et al. Cost and quality of life outcome analysis of postoperative infections after subaxial dorsal cervical fusions. J Neurosurg Spine. 2015; 22 (4): 381-386.

  19. Parker SL, Shau DN, Mendenhall SK, McGirt MJ. Factors influencing 2-year health care costs in patients undergoing revision lumbar fusion procedures. J Neurosurg Spine. 2012; 16 (4): 323-328.

  20. Featherall J, Miller JA, Bennett EE, Lubelski D, Wang H, Khalaf T, et al. Implementation of an infection prevention bundle to reduce surgical site infections and cost following spine surgery. JAMA Surg. 2016; 151 (10): 988-990.




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