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Does Intrawound Vancomycin Application During Spine Surgery Create Vancomycin-Resistant Organism?
Silky Chotai1, Patty W Wright2, Andrew T Hale1
1Department of Orthopedics Surgery and Department of Neurological surgery, Vanderbilt University Medical Center, Nas-hville, Tennessee.
Background:
Surgical site infection (SSI) following spine surgery is a morbid and expensive complication. The use of intrawound vancomycin is emerging as a solution to reduce SSI. The development of vancomycin-resistant pathogens is an understandable concern.
Objective:
To determine the occurrence of vancomycin-resistant SSI in patients with and without use of intrawound vancomycin.
Methods:
Patients undergoing elective spine surgery were dichotomized based on whether intrawound vancomycin was applied. Outcome was occurrence of SSI requiring return to the operating room within postoperative 90 days. The intrawound culture and vancomycin minimal inhibitory concentrations (MIC) were reviewed. Analyses were conducted to compare the pathogen profile and MIC for vancomycin in patients who received vancomycin and those who did not.
Results:
Of the total 2802 patients, 43% (n = 1215) had intrawound vancomycin application during the index surgery. The use of vancomycin was associated with significantly lower deep SSI rates (1.6% [n = 20] vs 2.5% [n = 40], P = .02). The occurrence of Staphylococcus aureus SSI was significantly lower in the patients who had application of intrawound vancomycin (32% vs 65%, P = .003). None of the patients who had application of intrawound vancomycin powder, and subsequently developed an S aureus SSI, demonstrated pathogens with resistance to vancomycin. All patients had MIC < 2 μg/mL, the vancomycin susceptibility threshold. The occurrence of gram-negative SSI (28% vs 7%) and culture negative fluid collection (16% vs 5%) was higher in the vancomycin cohort.
Conclusions:
The use of intrawound vancomycin during the index spine surgery was protective against SSI following spine surgery. The application of intrawound vancomycin during index surgery does not appear to create vancomycin-resistant organisms in the event of an SSI.
Insights
Intrawound vancomycin significantly reduced surgical site infections (SSI) after spine surgery. Importantly, its use did not lead to vancomycin-resistant Staphylococcus aureus infections, addressing a key safety concern.
Area of Science:
- Orthopedic Surgery
- Infectious Disease
- Pharmacology
Background:
- Surgical site infections (SSI) are a significant complication in spine surgery, increasing morbidity and healthcare costs.
- Intrawound vancomycin is an emerging strategy to mitigate SSI risk.
- Concerns exist regarding the potential development of vancomycin-resistant pathogens with its use.
Purpose of the Study:
- To evaluate the incidence of vancomycin-resistant SSI in patients undergoing elective spine surgery.
- To compare SSI rates and pathogen profiles between patients who received intrawound vancomycin and those who did not.
Main Methods:
- A retrospective analysis of 2802 patients undergoing elective spine surgery.
- Patients were divided into two groups: those who received intrawound vancomycin and those who did not.
- Outcomes included SSI requiring reoperation within 90 days, pathogen analysis, and vancomycin minimum inhibitory concentrations (MIC).
Main Results:
- Intrawound vancomycin use was associated with significantly lower deep SSI rates (1.6% vs 2.5%, P = .02).
- Staphylococcus aureus SSI occurred less frequently in the vancomycin group (32% vs 65%, P = .003).
- No vancomycin resistance was observed in S. aureus SSIs among patients who received intrawound vancomycin; all had MIC < 2 μg/mL.
Conclusions:
- Intrawound vancomycin is effective in reducing SSI following spine surgery.
- The application of intrawound vancomycin does not appear to promote the development of vancomycin-resistant organisms in cases of SSI.