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Intrawound application of vancomycin changes the responsible germ in elective spine surgery without significant
B Mirzashahi1, M Chehrassan2, S M J Mortazavi1,3
1Orthopedic Department of Imam Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Purpose:
Surgical site infection (SSI) is a costly complication associated with spine surgery. The impact of intrawound vancomycin has not been strongly postulated to decrease the risk of surgical site infection. We designed study to determine whether intrawound vancomycin application reduces the risk of SSI in patients after spine surgery.
Methods:
A prospective randomized control trial study to evaluate the patients with elective spine surgery in a period of 15 month was designed. Patients were divided into two groups based on whether intrawound vancomycin was applied or not. The relative risk of SSI within postoperative 30 days was evaluated.
Results:
Three hundred and eighty patients were included in this study: degenerative spine pathologies and tumor 80% (304), trauma 11% (42) and deformity 9% (34). Intrawound vancomycin was used in 51% of patients. Prevalence of SSI was 2.7% in the absence of vancomycin use versus 5.2% with intrawound vancomycin. In multivariable regression model, those with higher number of levels exposed, postoperative ICU admission and obesity and use of instrumentation more than two levels had higher risk of developing SSI. In the treatment group Acinetobacter and Pseudomonas aeruginosa (20%) were the most common pathogens. In control group, Staphylococcus aureus and Acinetobacter (40%) were the most common organisms.
Conclusions:
Intrawound application of vancomycin after elective spine surgery was not associated with reduced risk of SSI and return to OR associated with SSI in our patients. However, the use of intrawound vancomycin changed the responsible infection germ.
Insights
Intrawound vancomycin did not reduce surgical site infections (SSI) in spine surgery patients. However, it did alter the types of bacteria causing infections, with Staphylococcus aureus being more prevalent in the control group.
Area of Science:
- Neurosurgery
- Infectious Disease
- Clinical Trials
Background:
- Surgical site infection (SSI) is a significant complication following spine surgery, leading to increased healthcare costs.
- The prophylactic role of intrawound vancomycin in preventing SSIs after spine surgery remains incompletely understood.
- This study aimed to investigate the efficacy of intrawound vancomycin in reducing SSI risk in elective spine surgery.
Purpose of the Study:
- To determine if the application of vancomycin directly into the surgical wound reduces the incidence of surgical site infection (SSI) in patients undergoing elective spine surgery.
- To evaluate the association between intrawound vancomycin use and the risk of developing SSI within 30 days post-operation.
Main Methods:
- A prospective randomized controlled trial was conducted over 15 months involving patients undergoing elective spine surgery.
- Patients were allocated into two groups: one receiving intrawound vancomycin and a control group without vancomycin.
- The primary outcome measured was the relative risk of SSI within 30 days post-surgery.
Main Results:
- A total of 380 patients were analyzed, with 51% receiving intrawound vancomycin.
- The prevalence of SSI was 2.7% in the no-vancomycin group versus 5.2% in the vancomycin group.
- Multivariable analysis identified increased levels exposed, ICU admission, obesity, and extensive instrumentation (>2 levels) as risk factors for SSI. Common pathogens differed between groups, with Staphylococcus aureus more frequent in the control group.
Conclusions:
- Intrawound vancomycin application was not associated with a decreased risk of surgical site infection or return to the operating room for SSI in this patient cohort.
- The use of intrawound vancomycin appeared to influence the spectrum of causative microorganisms, shifting the predominant pathogens observed.
- Further research may be warranted to explore specific patient subgroups or alternative prophylactic strategies.
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