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2021, Number 1

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Ortho-tips 2021; 17 (1)

Effectiveness of vancomycin powder in the prophylaxis of infection post-surgical in spine surgery

Caldera HG, Recillas HRI, Cob GNE

Language: Spanish
References: 20
Page: 25-31
PDF size: 197.69 Kb.


ABSTRACT

Due to its pharmacodynamic capacities and its properties at the level of the cell membrane, Vancomycin is considered one of the glycopeptides in clinical use as a first-line treatment against most Gram positive germs. Currently regarding the topical route, there is evidence that intra-wound application of antibiotics can minimize local infection after surgery. In procedures performed at the spinal level, vancomycin has gained importance in its topical use as prophylaxis. Objective: To analyze the efficacy of topical vancomycin in the prevention of infections at the surgical wound in vertebral surgery. Material and methods: A non-randomized, observational and comparative cohort study was carried out in 120 patients with instrumented cervical, thoracic and lumbar spine surgeries in the period from January 2019 to January 2020. In 60 cases with placement of 1 gr of topical vancomycin, and 60 not, in a non-randomized way. The patients were followed up during the first 90 days after surgery. Results: The relationship between vancomycin infection was not statistically significant, identified five cases of wound infection in the group without vancomycin, it was found that the factor age less than 50 years and traumatic pathology presents an RR of (0.5833) and (0.2262) respectively, although without p ≤ 0.05, another finding was the RR (2.0208) in a lumbar level instrumented but without significant difference; the main characteristics in the 5 patients with wound infection were only present in the group without vancomycin, identifying their age, type of pathology, instrumented level and present comorbidities. Conclusions: There is no statistical significance in our study that topical vancomycin play a fundamental role in the prevention of infection at the surgical wound in spinal surgery. However, it is important to note that all infected patients in this work belonged to group B (without use of vancomycin).


REFERENCES

  1. Burke A. Vancomycin. Antimicrobial therapy II. Med Clin North Am. 1995; 79: 817-831.

  2. Donald P. Vancomycin: a history. Clin Infect Dis. 2006; 42: S5-S12.

  3. Mark P. Vancomycin. Mayo Clin Proc. 1991; 66: 1165-1170.

  4. Dennis L. The role of vancomycin in the treatment paradigm. Clin Infect Dis. 2006; 42: S51-S57.

  5. Kanj W, Flynn J, Spiegel D, Dormans J. Vancomycin prophylaxis of surgical site infection in clean orthopedic surgery. Orthopedics. 2013; 36 (2): 138-146.

  6. Melichercik P, Klapkova E, Landor I. The effect of vancomycin degradation products in the topical treatment of osteomyelitis. Bratisl Lek Listy. 2014; 115 (12): 796-799.

  7. Baron J, Shamrock A, Cates W. Graft preparation with intraoperative vancomycin decreases infection after ACL reconstruction. J Bone Joint Surg Am. 2019; 101: 2187-2193.

  8. Heckman N, Mayfield C, Culvern C. Systematic review & meta-analysis of intrawound vancomycin in total hip and total knee arthroplasty: a call for a prospective randomized trial. J Arthroplasty. 2019; 34: 1815-1822.

  9. Chen A, Fleischman A, Austin M. Use of intrawound antibiotics in orthopaedic surgery. J Am Acad Orthop Surg. 2018; 26: e371-e378.

  10. O'Toole R, Joshi M, Carlini A. 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 (4): S18-S24.

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

  12. Joshua B, Nader S, Sandi K. 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.

  13. George M, David W, Kim W. Complications from the use of intrawound vancomycin in lumbar spinal surgery: a systematic review. Neurosurg Focus. 2015; 39 (4): E11.

  14. Hiroshi T, Yasuaki I, Yuichirou Y. Use of intrawound vancomycin powder against postoperative infection after spine surgery. Spine Surg Relat Res. 2018; 2 (1): 18-22.

  15. Abhiram G, Alex R, Torin C. Selection pressures of vancomycin powder use in spine surgery: a metaanalysis. Spine J. 2019; 19 (6): 1076-1084.

  16. Sipeng L, Hongtao R, Xueqin Z. Metaanalysis of topical vancomycin powder for microbial profile in spinal surgical site infections. Eur Spine J. 2019; 28 (12): 2972-2980.

  17. Sombat K, Sirichai S, Chaiwat P. 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: 710-714.

  18. Justin V, Cumhur O, Sebastiaan P. 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.

  19. Alcalá G, Paternina A, Moscote L. 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 (3): 182-191.

  20. Fabian L, Félix S, Martín G. 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 (2): 158-164.




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