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Vancomycin Effectiveness in Reducing Surgical Site Infection in Posterior Spinal Fusion Surgery: A Retrospective Data
Aditya Joshi1, Ryan M Schiedo, Rachel S Bronheim
1Department of Orthopaedic Surgery, Johns Hopkins University National Capital Region, Bethesda, MD.
Study Design:
Retrospective analysis of prospectively collected data.
Objective:
To re-evaluate vancomycin as a preventive measure for surgical site infection (SSI).
Summary Of Background Data:
Intrawound vancomycin powder is used to prevent SSIs in spinal surgery. Prior studies, often limited to single institutions or small samples, have shown mixed efficacy and potential increases in non- S. aureus and Gram-negative infections. We hypothesized that SSIs rates would be similar with and without intrawound vancomycin in posterior spinal fusion (PSF) surgery.
Methods:
Prospectively collected data from the 3595 patients in the STaphylococcus aureus suRgical Inpatient Vaccine Efficacy (STRIVE) trial were stratified by intrawound antibiotic usage. Multivariate logistic regression assessed the effect of vancomycin use on SSI, adjusting for patient demographics and SSI-associated risk factors. Secondary outcomes included critical care stay, reoperation, sepsis, and hospital readmission.
Results:
Of 3311 patients who underwent surgery, 847 (26%) received only intrawound vancomycin and 1534 (46%) received no intrawound antibiotics. Sixty (8%) patients developed postoperative SSI, of whom 20 (33%) had received intrawound vancomycin. Receiving intrawound vancomycin was not associated with SSI incidence versus no intrawound antibiotics [odds ratio (OR): 0.77; 95% CI: 0.42-1.42], critical care stay (OR: 0.94; 95% CI: 0.78-1.12), or sepsis (OR: 2.04; 95% CI: 0.62-6.73). However, intrawound vancomycin was associated with increased odds of hospital readmission (OR: 1.82; 95% CI: 1.28-2.6; P < 0.001) and reoperation (OR: 1.75; 95% CI: 1.18-2.6; P = 0.005). Factors significantly associated with intrawound vancomycin use included intraoperative antibiotic readministration (OR: 2.97; 95% CI: 1.36-6.5; P =0.006) and hospital location, lower odds in Europe (OR: 0.13; 95% CI: 0.06-0.29; P < 0.001) or Asia (OR: 0.02; 95% CI: 0-0.08; P < 0.001) versus North America.
Conclusions:
Intraoperative vancomycin use was not associated with reduced SSI incidence compared with no intrawound antibiotics after PSF surgery.
Level Of Evidence:
Level II.
Insights
Intrawound vancomycin powder did not reduce surgical site infection (SSI) rates in posterior spinal fusion (PSF) surgery. However, its use was linked to higher hospital readmission and reoperation rates, suggesting a need to reevaluate its preventive role.
Area of Science:
- Spinal Surgery
- Infectious Disease Prevention
- Pharmacology
Background:
- Intrawound vancomycin powder is utilized to prevent surgical site infections (SSIs) in spinal surgery.
- Previous studies on vancomycin's efficacy have yielded mixed results and raised concerns about increased non-S. aureus and gram-negative infections.
- This study hypothesized that SSI rates would be comparable with or without intrawound vancomycin in posterior spinal fusion (PSF) procedures.
Purpose of the Study:
- To reevaluate the effectiveness of vancomycin as a preventive measure against surgical site infections (SSIs).
- To assess the association between intrawound vancomycin use and SSI incidence, critical care stay, sepsis, hospital readmission, and reoperation in PSF surgery.
Main Methods:
- Retrospective analysis of prospectively collected data from 3,311 patients undergoing PSF surgery within the STRIVE trial.
- Patients were stratified based on the use of intrawound antibiotics (vancomycin or none).
- Multivariate logistic regression was employed to analyze the impact of vancomycin on SSI and secondary outcomes, adjusting for relevant risk factors.
Main Results:
- No significant difference in SSI incidence was observed between patients receiving intrawound vancomycin and those who did not (OR = 0.77; 95% CI 0.42-1.42).
- Intrawound vancomycin use was associated with increased odds of hospital readmission (OR 1.82; P < .001) and reoperation (OR 1.75; P = .005).
- Factors influencing vancomycin use included intraoperative antibiotic readministration and geographic location, with lower usage in Europe and Asia compared to North America.
Conclusions:
- Intraoperative vancomycin powder administration was not associated with a reduction in SSI incidence following PSF surgery.
- The findings suggest that current practices of using intrawound vancomycin for SSI prevention in PSF may not be beneficial and could be associated with adverse outcomes like increased readmissions and reoperations.
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