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Do Dose-Dependent Microbial Changes Occur during Spine Surgery as a Result of Applying Intrawound Vancomycin Powder?:

Lunli Xie1,2, Jun Zhu1,2, Shunhong Luo3

  • 1The Minimally Invasive Department of Orthopedics, Rehabilitation Medical Center, The First Peoples's Hospital of Huaihua (Jishou University of the Fourth Affiliated Hospital), Huaihua, China.

Asian Spine Journal
|March 6, 2018
PubMed

Insights

Intrawound vancomycin powder in spine surgery may alter bacteria in surgical wounds. Higher doses (2g) correlated with gram-positive bacteria, while lower doses (1g) showed a dominance of gram-negative bacteria.

Area of Science:

  • Orthopedic Surgery
  • Infectious Disease
  • Pharmacology

Background:

  • Intrawound vancomycin powder is used in spine surgery to reduce infection rates.
  • Potential risks include altered bacterial profiles, impaired bone fusion, and systemic toxicity.

Purpose of the Study:

  • To analyze the dose-dependent effects of vancomycin on wound infection bacteria.
  • To investigate the relationship between vancomycin dose and microbial imbalances in spine surgery patients.

Main Methods:

  • Systematic review of PubMed articles published since October 2016.
  • Included studies focused on local, intrawound, intraoperative, or topical vancomycin in spinal surgery.
  • Data extracted included vancomycin dose, infecting bacteria, sample size, infection rates, and perioperative antibiotics.

Main Results:

  • Analysis of 10 studies involving 2,394 patients using 1g or 2g of local vancomycin powder.
  • Gram-negative bacteria were dominant with 1g vancomycin, while gram-positive bacteria predominated with 2g.
  • The observed shift in bacterial dominance is dose-dependent but the mechanism is unclear.

Conclusions:

  • Topical vancomycin use can alter wound bacterial trends in spine surgery.
  • An increase in gram-negative bacteria with intrawound vancomycin warrants attention.
  • Further randomized controlled trials are necessary to clarify the vancomycin dose-microbial change relationship.
Keywords:
Adverse effectsDosageSpine surgerySurgical wound infectionVancomycin

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