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Clinical Research
DOI: 10.1016/j.neucie.2019.07.003
Available online 13 November 2019
Vancomycin powder for the prevention of surgical site infection in posterior elective spinal surgery
Polvo de vancomicina tópico para la prevención de infección de herida quirúrgica en cirugía electiva de columna por vía posterior
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Pedro David Delgado-Lópeza,
Corresponding author
pedrodl@yahoo.com

Corresponding author.
, Javier Martín-Alonsoa, Vicente Martín-Velascoa, José Manuel Castilla-Díeza, Ana Galacho-Harrieroa, Sara Ortega-Cuberoa, Ana Isabel Herrero-Gutiérrezb, Antonio Rodríguez-Salazara
a Servicio de Neurocirugía, Hospital Universitario de Burgos, Burgos, Spain
b Departamento de Enfermería de Neurocirugía, Hospital Universitario de Burgos, Burgos, Spain
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Received 20 May 2019. Accepted 25 July 2019
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Tables (6)
Table 1. Description of the clinical and demographic findings of the cohort. Comparison of the two study groups.
Table 2. Results of the prospective study. Proportion and risk of superficial and deep surgical site infection and overall risk in both groups.
Table 3. Risk factors for deep surgical site infection in the whole cohort. The risk is shown by OR and the statistical significance value.
Table 4. Description of the cases of deep surgical site infection in the vancomycin group.
Table 5. Description of the cases of deep surgical site infection in the control group.
Table 6. Summary of systematic reviews and meta-analyses evaluating the effect of vancomycin powder on the incidence of surgical site infection in spine surgery.
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Abstract
Objective

To assess the effectiveness and safety of vancomycin powder as surgical siteinfection (SSI) prophylaxis in posterior bilateral elective spinal surgery.

Materials and methods

Single-center quasi-experimental pre and postintervention compa-rative cohort study. The post-intervention group received standard intravenous antibioticprophylaxis plus 1 g of vancomycin powder into the surgical field before wound closure, andthe pre-intervention group only the intravenous prophylaxis.

Results

150 patients were included in each group. Twelve SSI (7 superficial and 5 deep)occurred in the post-intervention group and 16 SSI (7 superficial and 9 deep) in the pre-intervention group. The risk of deep SSI decreased from 6.0% to 3.3% (OR 0,54, 95%CI 0.17-1.65, p=0.411) with vancomycin powder. The percentage of deep SSI due to gramnegative-positive germs were 80%-20% and 33%–67% for the post- and pre-interventiongroups, respectively (p=0.265). No local or systemic adverse effects occurred attributableto vancomycin powder.

Conclusion

In posterior elective spinal surgery, prophylaxis with vancomycin powder didnot result in a significantly reduced incidence of superficial and deep SSI. There was a trendtowards a higher incidence of deep SSI caused by gram negative microorganisms amongthose treated with vancomycin.

Keywords:
Vancomycin powder
Surgical site infection
Prophylaxis
Laminectomy
Arthrodesis
Resumen
Objetivo

Evaluar la efectividad y seguridad del polvo de vancomicina tópico como profilaxisde infección de herida quirúrgica (IHQ) en cirugía de columna electiva por abordaje posterior.

Material y métodos

Estudio unicéntrico cuasiexperimental de comparación pre- y postin-tervención. El grupo postintervención recibió profilaxis antibiótica estándar preoperatoriajunto a 1 g de polvo de vancomicina en el lecho quirúrgico antes del cierre de la herida. Elgrupo preintervención solo recibió la profilaxis intravenosa.

Resultados

Participaron 150 pacientes en cada grupo. Ocurrieron 12 infecciones (7 super-ficiales, 5 profundas) en el grupo postintervención y 16 infecciones (7 superficiales, 9profundas) en el grupo preintervención. El riesgo de IHQ profunda se redujo del 6% al 3,3% (OR 0,54; IC 95% 0,17–1,65; p=0,411) con el tratamiento. El porcentaje de IHQ profunda porgramnegativos-positivos fue del 80-20% en el grupo tratado con vancomicina y del 33–67% en los no tratados (p=0,265). No se produjeron efectos adversos locales ni sistémicos por eltratamiento.

Conclusión

La profilaxis con polvo de vancomicina en cirugía electiva de columna por abor-daje posterior no redujo de forma significativa la incidencia de IHQ superficial o profunda. Seconstató una tendencia al aumento de IHQ profunda por microorganismos gramnegativosen los tratados con vancomicina.

Palabras clave:
Polvo de vancomicina
Infección de herida quirúrgica
Profilaxis
Laminectomía
Artrodesis

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