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Use of vancomycin powder shown to reduce infection rates in spinal fusion
O’Neill KR. Spine J. 2011. doi:10.1016/j.spinee.2011.04.025.
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The incidence of infection in patients with traumatic spine injury who undergo instrumented posterior spine fusion may be reduced through the use of vancomycin powder, according to this study from Vanderbilt University researchers.
The team performed a retrospective review of 110 patients who underwent instrumented posterior spine fusions for traumatic spine injuries during a 2-year period. The treatment group (54 patients) received vancomycin powder in their surgical wounds as well as systemic prophylaxis, while the control group (56 patients) received only standard systemic prophylaxis.
Data on history of previous spine surgeries, diabetes, substance use, body mass index, operative time, estimated blood loss, level of injury and presence of neurologic deficit were obtained by the research team. The primary study outcome was the incidence of infection.
The researchers found the control and treatment groups to be statistically similar, but noted a statistically significant difference in infection rate between the groups. They found an infection rate of 0% in the treatmen group vs. 13% in the control group.
There were no adverse effects noted in the study.
“Applying vancomycin powder to surgical wounds is a promising means of preventing costly and harmful postoperative wound infections in high-risk populations,” the authors wrote.
This article reports a dramatic decrease in wound infection rate with the addition of vancomycin powder in the surgical wound in addition to standard systemic prophylaxis. It is not clear if these results would extrapolate to non-traumatic spine fusions, or fusions in challenged hosts, but in the setting of traumatic spine injury the results are clear. With any antibiotic usage we must always be wary of fostering resistant bacteria. In a situation with an expected infection rate greater than 5% it would seem this approach is worth considering.
— Scott D. Boden, MD
Professor of Orthopedic Surgery
Director
Emory Orthopaedics & Spine Center
The results of this study demonstrating substantial and significant decrease in wound infection in the setting of trauma are quite compelling. This group of patients, as well as our patients suffering from malignant/metastatic conditions, represent the highest risk for postoperative infection. This is not the first report demonstrating the utility of vancomycin powder in decreasing infection risk. While creation of resistance is a concern, the closed environment in the wound and the significant bactericidal activity of the treatment should offset this risk. Clearly this is a technique that bears further careful study given the current compelling results.
— Todd J Albert, MD
Richard H Rothman Professor and Chairman
Department of Orthopaedic Surgery
Professor of Neurosurgery
Thomas Jefferson University and Hospitals
Philadelphia, Pa.