Chiaki Horii1, Takashi Yamazaki2, Hiroyuki Oka3, Seiichi Azuma4, Satoshi Ogihara5, Rentaro Okazaki4, Naohiro Kawamura6, Yuichi Takano7, Jiro Morii8, Yujiro Takeshita9, Toru Maruyama10, Kiyofumi Yamakawa11, Motoaki Murakami12, Yasushi Oshima13, Sakae Tanaka13. 1. Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo Hospital, 113-8655, 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan. Electronic address: harukabc@gmail.com. 2. Department of Orthopaedic Surgery, Musashino Red Cross Hospital, Sakaiminami Cho 1-26-1, Musashino City, Tokyo 180-8610, Japan. 3. Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical & Research Center, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan. 4. Department of Orthopaedic Surgery, Saitama Red Cross Hospital, Shintoshin 1-5, Chuo-Ku, Saitama City, Saitama 330-8553, Japan. 5. Department of Orthopaedic Surgery, Saitama Medical Center, Saitama Medical University, Kitaurawa 4-9-3, Urawa-Ku, Saitama City, Saitama 330-0074, Japan. 6. Department of Spine and Orthopaedic Surgery, Japanese Red Cross Medical Center, Hiroo 4-1-22, Shibuya-Ku, Tokyo 150-8935, Japan. 7. Department of Orthopaedic Surgery, Iwai Orthopaedic Medical Hospital, Minami Koiwa 8-17-2, Edogawa-Ku, Tokyo 133-0056, Japan. 8. Department of Orthopaedic Surgery, Sanraku Hospital, Kanda Surugadai 2-5, Chiyoda-Ku, Tokyo 101-8326, Japan. 9. Department of Spine Surgery, Yokohama Rosai Hospital, Kodukue Cho 3211, Kohoku-Ku, Yokohama City, Kanagawa 222-0036, Japan. 10. Department of Orthopaedic Surgery, Saitama Prefectural Rehabilitation Center, Nishi Kaiduka 148-1, Ageo City, Saitama 362-0057, Japan. 11. Department of Orthopaedic Surgery and Musculoskeletal Oncology, Tokyo Metropolitan Komagome Hospital, Honkomagome 3-18-22, Bunkyo-Ku, Tokyo 113-0021, Japan. 12. Department of Orthopaedic Surgery, Toranomon Hospital, Toranomon 2-2-2, Minato-Ku, Tokyo 105-8470, Japan. 13. Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo Hospital, 113-8655, 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan.
Abstract
BACKGROUND CONTEXT: Recent reports suggested that placing vancomycin powder into surgical wounds before closure can prevent surgical site infections (SSIs) in spinal surgery. PURPOSE: The present study aimed to evaluate if intrawound vancomycin powder could prevent SSIs after spinal surgery with posterior instrumentation. STUDY DESIGN: This is a multicenter retrospective cohort study using propensity score matching. PATIENT SAMPLE: We reviewed all spinal surgeries performed with posterior instrumentation from July 2012 to December 2014 at 11 institutions among patients aged ≥15 years. OUTCOME MEASURES: The incidence of SSIs was compared between patients who received intrawound vancomycin powder (vancomycin group) and those who did not (control group). METHODS: Demographic and operative data and microbiological findings of SSI cases were analyzed. After a preliminary whole-cohort analysis, we performed one-to-one propensity score matching to adjust for the differences between the two groups and then compared the incidence of SSIs between the matched groups. No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript. RESULTS: A total of 2,859 patients were included in the study. In the vancomycin and control groups (n=694 and n=2165, respectively), 12 (1.73%) and 21 (0.97%) patients developed SSIs, respectively, but the difference was not statistically significant (p=.10, chi-square test). During the propensity score-matched analysis, 507 pairs were analyzed. No significant change in the rate of SSIs was seen between the vancomycin and control groups (8 SSIs [1.58%] vs. 9 SSIs [1.78%], respectively; p=.81, chi-square test). Microbiological analysis revealed that 5 of 12 (42%) and 11 of 21 (52%) SSIs in the vancomycin and control groups, respectively, were caused by Staphylococcus (p=.72, Fisher exact test). CONCLUSIONS: Intrawound application of vancomycin powder was not associated with a significant decrease in the incidence of SSIs after posterior instrumented spinal surgeries in a propensity score-matched analysis. However, the rate of infections caused by Staphylococcus species was lower in the vancomycin group.
BACKGROUND CONTEXT: Recent reports suggested that placing vancomycin powder into surgical wounds before closure can prevent surgical site infections (SSIs) in spinal surgery. PURPOSE: The present study aimed to evaluate if intrawound vancomycin powder could prevent SSIs after spinal surgery with posterior instrumentation. STUDY DESIGN: This is a multicenter retrospective cohort study using propensity score matching. PATIENT SAMPLE: We reviewed all spinal surgeries performed with posterior instrumentation from July 2012 to December 2014 at 11 institutions among patients aged ≥15 years. OUTCOME MEASURES: The incidence of SSIs was compared between patients who received intrawound vancomycin powder (vancomycin group) and those who did not (control group). METHODS: Demographic and operative data and microbiological findings of SSI cases were analyzed. After a preliminary whole-cohort analysis, we performed one-to-one propensity score matching to adjust for the differences between the two groups and then compared the incidence of SSIs between the matched groups. No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript. RESULTS: A total of 2,859 patients were included in the study. In the vancomycin and control groups (n=694 and n=2165, respectively), 12 (1.73%) and 21 (0.97%) patients developed SSIs, respectively, but the difference was not statistically significant (p=.10, chi-square test). During the propensity score-matched analysis, 507 pairs were analyzed. No significant change in the rate of SSIs was seen between the vancomycin and control groups (8 SSIs [1.58%] vs. 9 SSIs [1.78%], respectively; p=.81, chi-square test). Microbiological analysis revealed that 5 of 12 (42%) and 11 of 21 (52%) SSIs in the vancomycin and control groups, respectively, were caused by Staphylococcus (p=.72, Fisher exact test). CONCLUSIONS: Intrawound application of vancomycin powder was not associated with a significant decrease in the incidence of SSIs after posterior instrumented spinal surgeries in a propensity score-matched analysis. However, the rate of infections caused by Staphylococcus species was lower in the vancomycin group.
Authors: Yehuda E Kerbel; Gregory J Kirchner; Anisha Reddy Sunkerneni; Alexander M Lieber; Vincent M Moretti; Amrit S Khalsa; Marc J Levine Journal: Global Spine J Date: 2019-11-12
Authors: Rawan T Tafish; Ahmed F Alkhaldi; Anouar Bourghli; Turki A Althunian Journal: Antimicrob Resist Infect Control Date: 2021-09-26 Impact factor: 4.887