AI Summary & Key Takeaways
AI InsightThe benefit of vancomycin application may be most appreciated in higher risk populations or in clinicswith high baseline rates of infection.Level of Evidence: Level III, Therapeutic Study
📌 3 Key Takeaways
Özet
Objective: This study aimed to determine the efficacy of prophylactic use of vancomycin powder against surgical site infections in patientswith high-risk conditions who underwent posterior spinal instrumentation.Methods: Data obtained from 209 patients who underwent posterior spinal instrumentation at a single institution from 2014 to 2017 were retrospectively reviewed. Patients were then divided into two groups: control group, including 107 patients (61 females, 46 males; mean age=54years; age range=16-85 years), and treatment group, including 102 patients (63 females, 39 males; mean age=53 years; age range=14-90 years).All patients received the same standard prophylactic antibiotic regimen. In addition to the prophylactic antibiotic, vancomycin powder wasapplied locally to the surgical site in the treatment group. All patients were followed up for at least 90 days postoperatively. Infections werecategorized as superficial and deep infections. Subgroup analysis of high-risk patients (Syrian refugees) was also performed.Results: The infection rates were 1.96% (two patients) in the treatment group and 6.54% (seven patients) in the control group. A significantdecrease in the infection rates was observed with local vancomycin powder application. Advanced age (>46 years) and prolonged surgicalduration (>140 min) were found to be the main risk factors for surgical site infections (p=0.004 and p=0.028, respectively). The infectionrates were 3.22% and 8.11% in the treatment and control groups of refugees, respectively. There were three superficial and four deep infections in the control group and one superficial and one deep infection in the treatment group. A dominance of staphylococcus infectionswas observed in the control group, whereas no significant dominance was observed in the treatment group. Three patients in the controlgroup and one patient in the treatment group received implant removal.Conclusion: Evidence from this study has revealed that local application of vancomycin powder reduces the rate of surgical site infectionsafter instrumented spinal surgery. The benefit of vancomycin application may be most appreciated in higher risk populations or in clinicswith high baseline rates of infection.Level of Evidence: Level III, Therapeutic Study