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Topical Vancomycin in Pediatric Spine Surgery Does Not Reduce Surgical Site Infection: A Retrospective Cohort Study

Overview
Journal Spine Deform
Publisher Springer Nature
Date 2018 Aug 21
PMID 30122387
Citations 13
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Abstract

Study Design: Retrospective cohort study.

Objectives: Evaluate the effectiveness of topical vancomycin in reducing surgical site infection (SSI) in pediatric patients undergoing posterior spinal fusion (PSF).

Summary Of Background Data: There has been increased interest in use of topical vancomycin to reduce SSI in spine surgery with mixed results reported in the literature. In Summer 2012, our institution implemented the use of topical vancomycin in definitive primary and revision PSF as part of our infection control protocol.

Methods: After IRB approval, a consecutive series of 527 patients (538 procedures) undergoing PSF January 2010-December 2014 were retrospectively reviewed to identify the occurrence of SSI. Based on published results from a similar study, an a priori power analysis determined 190 patients were needed per group to achieve 0.90 power. In 228 procedures, topical vancomycin was used (Vanco) and in 310 procedures it was not (No Vanco). Exclusion criteria were <90 days follow-up, >18 years at time of surgery, and combined anterior and posterior fusion. Two-sample t tests, Wilcoxon rank-sum tests, and Fisher exact tests were used to compare the cohorts.

Results: Groups were similar in age, sex, implant density, fusion length, risk categorization, and surgical time (p > .05). No Vanco had significantly higher blood loss and incidence and amount of intraoperative allogenic transfusion (p < .001). Incidence of SSI was 3% (7/228) in Vanco and 2% (6/310) in No Vanco (p = .4099). Six of the 7 SSIs occurred in high-risk patients in Vanco and 5 of 6 occurred in high-risk patients in No Vanco (p = 1). Reoperation within 90 days was 6% (13/228) in Vanco and 4% (11/310) in No Vanco (p = .2912). Occurrence of other complications was similar between Vanco, 3% (7/228), and No Vanco, 2% (5/310).

Conclusion: Use of topical vancomycin did not reduce incidence of SSI for pediatric patients undergoing PSF at our institution.

Level Of Evidence: Level III.

Citing Articles

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PMID: 39811169 PMC: 11726485.


Risk-Adapted Use of Vancomycin in Secondary Scoliosis Surgery May Normalize SSI Risk in Surgical Correction of High-Risk Patients.

Taheri N, Kohli P, Li Z, Wang Z, Vu-Han T, Cloeren K J Pers Med. 2024; 14(10).

PMID: 39452525 PMC: 11508918. DOI: 10.3390/jpm14101017.


The effect of antibiotic-impregnated calcium sulfate beads and Medical Optimization Clinic attendance on the acute surgical site infection rate in high-risk pediatric neuromuscular and syndromic scoliosis patients.

Reddy Y, Jamnik A, Thornberg D, Datcu A, Lachmann E, Johnson M Spine Deform. 2024; 12(4):1089-1098.

PMID: 38457028 DOI: 10.1007/s43390-024-00837-8.


A meta-analysis examining the impact of intrawound treatment on reducing deep surgical site infections during instrumented spine surgery.

Zhou L, Xing S Int Wound J. 2023; 21(4):e14554.

PMID: 38151914 PMC: 10961050. DOI: 10.1111/iwj.14554.


Intra-wound versus systemic vancomycin for preventing surgical site infection induced by methicillin-resistant S. aureus after spinal implant surgery in a rat model.

Wei J, Gu H, Tong K J Orthop Surg Res. 2023; 18(1):299.

PMID: 37055765 PMC: 10100431. DOI: 10.1186/s13018-023-03779-5.