Local vancomycin administration in Orthopaedic Surgery - A systematic review of comparative studies

Area of Science:

• Orthopaedic Surgery
• Infectious Disease Control
• Pharmacology

Background:

• Controversy exists regarding the routine use of vancomycin in primary orthopaedic procedures.
• Surgical site infections (SSIs) remain a significant concern in orthopaedic surgery.

Purpose of the Study:

• To systematically review the impact of local vancomycin on infection rates and microbiology in primary orthopaedic surgery.
• To assess the efficacy and safety of local vancomycin application across different orthopaedic subspecialties.

Main Methods:

• Systematic electronic search of MEDLINE, EMBASE, and Web of Science.
• Inclusion of comparative studies published before August 14, 2022.
• Analysis of 61 studies involving 65,671 patients.

Main Results:

• Local vancomycin significantly decreased infection rates in spine surgery and sports medicine.
• Increased proportions of gram-negative bacteria were observed in arthroplasty and trauma surgery with vancomycin use.
• No systemic adverse reactions were reported with local vancomycin application.

Conclusions:

• Local vancomycin application may reduce SSIs in primary orthopaedic surgery, particularly in spine and sports medicine.
• Careful consideration is warranted due to study heterogeneity and potential shifts in bacterial resistance patterns.
• Further research may be needed to optimize vancomycin use in specific orthopaedic procedures.