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Drain blockage by topical vancomycin powder-a case report of a potentially catastrophic complication in spine surgery
1Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
Background:
There is evidence that application of vancomycin powder reduces the incidence of surgical site infection (SSI) and is also effective for the treatment of infections requiring surgical debridement. The use of intrawound vancomycin powder is therefore becoming prevalent. Surgical drain occlusion by antibiotic powder is a potentially serious complication that has yet to be reported in the literature.
Case Description:
We describe a 62-year-old female with L4/5 spondylodiscitis as well as an L1-S1 epidural abscess who presented with back pain, lower limb numbness and weakness. Urgent surgical drainage was performed via a hemilaminectomy and L4/5 diskectomy. Drain output was absent for the first 36 hours post-op, and upon inspection and disconnection of the distal drain tubing, vancomycin powder residue was noted to be deposited within the lumen and connection point to cause complete obstruction. Following tubing exchange, drainage output resumed. The patient experienced relief of her back and leg symptoms after surgery as well as a normalization of her inflammatory markers upon receiving a course of intravenous (IV) antibiotics.
Conclusions:
Drain occlusion from antibiotic powder may be catastrophic following spine surgery due to the risk of epidural hematoma formation followed by compression of neural elements. We review the physicochemical properties of vancomycin powder and discuss ways to prevent this complication from occurring.
Insights
Vancomycin powder, used to prevent surgical site infections (SSI), can obstruct surgical drains. This case highlights the risk of drain occlusion by vancomycin powder after spine surgery.
Area of Science:
- Neurosurgery
- Infectious Disease
- Surgical Complications
Background:
- Vancomycin powder is increasingly used to reduce surgical site infections (SSI) and treat infections requiring debridement.
- Intrawound vancomycin powder application is becoming prevalent in surgical practice.
- Surgical drain occlusion by antibiotic powder is a potential complication that has not been previously reported.
Observation:
- A 62-year-old female with spondylodiscitis and epidural abscess experienced absent drain output post-hemilaminectomy and diskectomy.
- Inspection revealed complete obstruction of the surgical drain by vancomycin powder residue.
- Drainage resumed after the surgical tubing was exchanged.
Findings:
- The case demonstrates that vancomycin powder can cause complete surgical drain occlusion.
- Physicochemical properties of vancomycin powder may contribute to this obstruction.
- Early identification and intervention (tubing exchange) resolved the drain occlusion.
Implications:
- Surgical drain occlusion by vancomycin powder can be catastrophic, potentially leading to epidural hematoma and neural compression.
- Awareness of this complication is crucial for spine surgeons using vancomycin powder.
- Strategies to prevent drain occlusion by antibiotic powder should be developed and implemented.
