CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2019; 54(06): 617-626
DOI: 10.1016/j.rbo.2017.12.003
Artigo de Revisão
Sociedade Brasileira de Ortopedia e Traumatologia. Published by Thieme Revnter Publicações Ltda Rio de Janeiro, Brazil

Infectious Prophylaxis with Intrawound Vancomycin Powder in Orthopedic Surgeries: Systematic Review with Meta-Analysis[*]

Article in several languages: português | English
1  Clínica Ortopédica Traumatológica, Centro de Estudos em Ortopedia e Traumatologia (COT-CEOT), Salvador, BA, Brasil
,
Mariana Drummond Sousa
1  Clínica Ortopédica Traumatológica, Centro de Estudos em Ortopedia e Traumatologia (COT-CEOT), Salvador, BA, Brasil
,
Yasmin Galvão Linhares Cajaíba
2  Faculdade de Tecnologia e Ciências (FTC), Salvador, BA, Brasil
,
Rodrigo Rêgo Martins
1  Clínica Ortopédica Traumatológica, Centro de Estudos em Ortopedia e Traumatologia (COT-CEOT), Salvador, BA, Brasil
,
Diogo Maciel Vieira Lobão
2  Faculdade de Tecnologia e Ciências (FTC), Salvador, BA, Brasil
› Author Affiliations
Further Information

Publication History

22 September 2017

07 December 2017

Publication Date:
23 September 2019 (online)

Abstract

Despite many existing strategies used to reduce the rates of surgical site infection (SSI), these are still fairly frequent complications that pose a challenge for orthopedic surgeons. Therefore, the search for more effective methods of perioperative infection prophylaxis became a main subject of research, with the goal of decreasing postoperative morbidity, mortality, and costs. Thus, the present study sought to assess the effectiveness of intra-wound vancomycin powder in orthopedic surgery SSI prophylaxis.

A systematic review and meta-analysis study was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols 2015 (PRISMA-P 2015). A comprehensive literature search was performed to identify controlled studies on the rates of SSI with or without the local use of vancomycin powder. Exclusion and inclusion criteria were applied. A meta-analysis with random effects was performed.

Out of 412 titles that met the criteria, 7 studies regarding spine surgery were included: 4 prospective and 3 retrospective studies. A total of 6,944 cases were identified, and they were divided into 2 groups: the control group (3,814 patients), to whom intrawound vancomycin was not administered, and the intervention group (3,130 patients), to who vancomycin was administered locally. We observed that 64 (2.04%) patients in the intervention group developed SSI, in contrast to 144 (3.75%) patients in the control group. The results of the meta-analysis showed that the local use of vancomycin powder had an statistically significant protective effect against SSI in cases of spine surgery, with a relative risk (RR) of 0.59 and a 95% confidence interval (95%CI) of 0.35–0.98.

The use of prophylactic intrawound vancomycin powder has a protective effect against SSI in spine surgeries; however, further prospective trials are needed to endorse its use in orthopedic surgeries.

* Work developed at the Orthopedic Trauma Clinic, Centro de Estudos em Ortopedia e Traumatologia (COT-CEOT), Salvador, BA, Brazil. Originally Published by Elsevier.