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Does the Application of Topical Intrawound Vancomycin Powder Affect Deep Surgical Site Infection and the Responsible
Prashant Adhikari1,2, Vugar Nabi Nabiyev1, Sinan Bahadir1,3
1ARTES Spine Center, Acibadem Ankara Hospital, Ankara, Turkey.
Study Design:
Retrospective case series with a historical control group.
Purpose:
To compare the deep wound infection rates in patients undergoing spinal surgery with the application of topical intrawound vancomycin powder (TIVP) in the surgical site in addition to standard systemic prophylaxis with those in a matched historical cohort of patients for whom TIVP was not used.
Overview Of Literature:
Surgical site infection (SSI) after spine surgery is debilitating and is responsible for a significant increase in the health care costs, hospital stay, and morbidities. Although the application of TIVP before surgical closure is a promising method for reducing the SSI rate after spine surgery, its use is controversial, and currently, research trials are focusing on identifying its safety, efficacy, and the potential patient population.
Methods:
A group of 88 patients who underwent posterior spinal surgery with TIVP administration (treatment group) was compared to a historical control group of 70 patients who had received only standard systemic intravenous prophylaxis (control group) for the analysis of deep SSI rate and the involved organisms.
Results:
The overall rate of deep SSIs was 2.5% (4/158). All the SSIs were observed in patients who had posterior instrumentation and fusion for ≥3 levels. In the treatment group, the SSI rate was 3.4% (3/88), and the bacteria isolated were Escherichia coli (n=2) and Pseudomonas aeruginosa (n=1). In the control group, the infection rate was 1.4% (1/70), and the isolated bacteria were Morganella morganii and Staphylococcus epidermidis. No statistically significant association was found between the SSI rates of the treatment and control groups.
Conclusions:
Although the difference in the SSI rates was not statistically significant, the present results suggest that TIVP administration could not reduce the risk of deep SSIs after spinal surgery. Moreover, TIVP administration might also affect the underlying pathogens by increasing the propensity for gram-negative species.
Insights
Topical intrawound vancomycin powder (TIVP) did not significantly reduce deep surgical site infections (SSIs) in spinal surgery patients. This study suggests TIVP may alter pathogens, potentially favoring gram-negative bacteria.
Area of Science:
- Orthopedic Surgery
- Infectious Disease
- Clinical Research
Background:
- Spinal surgery can lead to debilitating surgical site infections (SSIs), increasing healthcare costs and patient morbidity.
- Topical intrawound vancomycin powder (TIVP) is explored as a method to reduce SSIs, but its efficacy and safety remain subjects of ongoing research.
- Understanding the impact of TIVP on SSI rates and pathogen profiles is crucial for optimizing patient care in spinal surgery.
Purpose of the Study:
- To evaluate the effectiveness of topical intrawound vancomycin powder (TIVP) in reducing deep surgical site infection (SSI) rates following spinal surgery.
- To compare SSI rates in patients receiving TIVP plus standard prophylaxis against a historical control group receiving only standard prophylaxis.
Main Methods:
- A retrospective case series design was employed, comparing a treatment group of 88 patients who received TIVP with a historical control group of 70 patients.
- Both groups underwent posterior spinal surgery; the treatment group received TIVP in addition to standard systemic prophylaxis, while the control group received only standard prophylaxis.
- Deep SSI rates and the specific microorganisms involved were analyzed to determine the impact of TIVP.
Main Results:
- The overall deep SSI rate was 2.5% (4/158), with all infections occurring in patients undergoing posterior instrumentation and fusion for three or more levels.
- The treatment group had an SSI rate of 3.4% (3/88), with infections caused by Escherichia coli and Pseudomonas aeruginosa.
- The control group had an SSI rate of 1.4% (1/70), with infections caused by Morganella morganii and Staphylococcus epidermidis. No statistically significant difference in SSI rates was observed between the groups.
Conclusions:
- Topical intrawound vancomycin powder (TIVP) administration did not demonstrate a statistically significant reduction in deep SSIs after spinal surgery in this study.
- The findings suggest that TIVP may not be effective in preventing deep SSIs in this patient population.
- There is a potential for TIVP to influence the types of pathogens involved in SSIs, possibly increasing the prevalence of gram-negative bacteria.
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