Application of Intrawound Vancomycin Powder during Spine Surgery in a Patient with Dialysis-Dependent Renal Failure

Area of Science:

• Neurosurgery
• Infectious Disease Prevention
• Pharmacology

Background:

• Surgical site infections (SSIs) are a significant risk after spinal surgery.
• Vancomycin is a common prophylactic agent but requires careful dosing in dialysis-dependent patients due to renal clearance and potential toxicity.
• Emerging vancomycin resistance complicates prophylaxis in these vulnerable populations.

Purpose of the Study:

• To evaluate the safety and efficacy of local vancomycin powder instillation for SSI prophylaxis in a dialysis-dependent patient undergoing spinal surgery.
• To assess systemic vancomycin absorption and potential toxicity in end-stage renal disease (ESRD) patients receiving intrawound vancomycin.

Main Methods:

• A case report of a patient with ESRD undergoing multilevel laminectomy and fusion.
• Intraoperative administration of 1 gram of vancomycin powder directly into the surgical wound prior to closure.
• Postoperative monitoring of serum vancomycin levels.

Main Results:

• Postoperative serum vancomycin levels remained well below the threshold for nephrotoxicity and ototoxicity.
• The patient experienced no signs of systemic vancomycin toxicity.
• This approach was considered a potentially safe and effective method for SSI prophylaxis.

Conclusions:

• Intrawound vancomycin powder instillation may be a safe and effective strategy for SSI prophylaxis in dialysis-dependent patients undergoing spinal surgery.
• This localized delivery method appears to minimize systemic absorption, mitigating risks associated with vancomycin in patients with renal failure.
• Further studies are warranted to confirm these findings in a larger cohort.