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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[*]

Artikel in mehreren Sprachen: português | English
David Sadigursky 
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
› Institutsangaben
Weitere Informationen

Publikationsverlauf

22. September 2017

07. Dezember 2017

Publikationsdatum:
23. September 2019 (online)

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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.

Keywords

vancomycin - surgical wound infection - orthopedics

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


 

  • Referências

  • 1 Bakhsheshian J, Dahdaleh NS, Lam SK, Savage JW, Smith ZA. The use of vancomycin powder in modern spine surgery: systematic review and meta-analysis of the clinical evidence. World Neurosurg 2015; 83 (05) 816-823
    CrossrefPubMedGoogle Scholar
  • 2 Van Hal M, Lee J, Laudermilch D, Nwasike C, Kang J. Vancomycin Powder regimen for prevention of surgical site infection in complex spine surgeries. Clin Spine Surg 2017; 30 (08) E1062-E1065
    PubMedGoogle Scholar
  • 3 Matar WY, Jafari SM, Restrepo C, Austin M, Purtill JJ, Parvizi J. Preventing infection in total joint arthroplasty. J Bone Joint Surg Am 2010; 92 (Suppl. 02) 36-46
    CrossrefPubMedGoogle Scholar
  • 4 Edelstein AI, Weiner JA, Cook RW. , et al. Intra-articular vancomycin powder eliminates methicillin-resistant s. aureus in a rat model of acontaminated intra-articular implant. J Bone Joint Surg Am 2017; 99 (03) 232-238
    CrossrefPubMedGoogle Scholar
  • 5 Kang DG, Holekamp TF, Wagner SC, Lehman Jr RA. Intrasite vancomycin powder for the prevention of surgical site infection in spine surgery: a systematic literature review. Spine J 2015; 15 (04) 762-770
    CrossrefPubMedGoogle Scholar
  • 6 Hey HW, Thiam DW, Koh ZS. , et al. Is intraoperative local vancomycin powder the answer to surgical site infections in spine surgery?. Spine 2017; 42 (04) 267-274
    CrossrefPubMedGoogle Scholar
  • 7 Sweet FA, Roh M, Sliva C. Intrawound application of vancomycin for prophylaxis in instrumented thoracolumbar fusions: efficacy, drug levels, and patient outcomes. Spine 2011; 36 (24) 2084-2088
    CrossrefPubMedGoogle Scholar
  • 8 Levine DP. Vancomycin: a history. Clin Infect Dis 2006; 42 (Suppl. 01) S5-S12
    CrossrefPubMedGoogle Scholar
  • 9 Martin JR, Adogwa O, Brown CR. , et al. Experience with intrawound vancomycin powder for spinal deformity surgery. Spine 2014; 39 (02) 177-184
    CrossrefPubMedGoogle Scholar
  • 10 Edin ML, Miclau T, Lester GE, Lindsey RW, Dahners LE. Effect of cefazolin and vancomycin on osteoblasts in vitro. Clin Orthop Relat Res 1996; (333) 245-251
    PubMedGoogle Scholar
  • 11 Tubaki VR, Rajasekaran S, Shetty AP. Effects of using intravenous antibiotic only versus local intrawound vancomycin antibiotic powder application in addition to intravenous antibiotics on postoperative infection in spine surgery in 907 patients. Spine 2013; 38 (25) 2149-2155
    CrossrefPubMedGoogle Scholar
  • 12 Moher D, Shamseer L, Clarke M. , et al; PRISMA-P Group. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 2015; 4 (01) 1 http://www.systematicreviewsjournal.com/content/4/1/1
    CrossrefPubMedGoogle Scholar
  • 13 Wells GA, Shea B, O'Connell D, Peterson J, Welch V, Losos M, Tugwell P. The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2009 . Available from: http://www.ohrica/programs/clinical epidemiology/oxford
    Google Scholar
  • 14 CEBM (Centre for Evidence-Based Medicine). Oxford Centre for Evidence-based Medicine—Levels of Evidence (March 2009) [cited 28 Jul 2009]. Available from: http://www.cebm.net/index.aspx?o=1025
    Google Scholar
  • 15 Horan TC, Culver DH, Gaynes RP, Jarvis WR, Edwards JR, Reid CR. ; National Nosocomial Infections Surveillance (NNIS) System. Nosocomial infections in surgical patients in the United States, January 1986-June 1992. Infect Control Hosp Epidemiol 1993; 14 (02) 73-80
    CrossrefPubMedGoogle Scholar
  • 16 Jarvis WR, Schlosser J, Chinn RY, Tweeten S, Jackson M. National prevalence of methicillin-resistant Staphylococcus aureus in inpatients at US health care facilities, 2006. Am J Infect Control 2007; 35 (10) 631-637
    CrossrefPubMedGoogle Scholar
  • 17 Finkelstein R, Rabino G, Mashiah T. , et al. Vancomycin versus cefazolin prophylaxis for cardiac surgery in the setting of a high prevalence of methicillin-resistant staphylococcal infections. J Thorac Cardiovasc Surg 2002; 123 (02) 326-332
    CrossrefPubMedGoogle Scholar
  • 18 Moehring HD, Gravel C, Chapman MW, Olson SA. Comparison of antibiotic beads and intravenous antibiotics in open fractures. Clin Orthop Relat Res 2000; (372) 254-261
    PubMedGoogle Scholar
  • 19 Ostermann PA, Seligson D, Henry SL. Local antibiotic therapy for severe open fractures. A review of 1085 consecutive cases. J Bone Joint Surg Br 1995; 77 (01) 93-97
    PubMedGoogle Scholar
  • 20 O'Neill KR, Smith JG, Abtahi AM. , et al. Reduced surgical site infections in patients undergoing posterior spinal stabilization of traumatic injuries using vancomycin powder. Spine J 2011; 11 (07) 641-646
    CrossrefPubMedGoogle Scholar
  • 21 Stall AC, Becker E, Ludwig SC, Gelb D, Poelstra KA. Reduction of postoperative spinal implant infection using gentamicin microspheres. Spine 2009; 34 (05) 479-483
    CrossrefPubMedGoogle Scholar
  • 22 Hanssen AD, Osmon DR, Patel R. Local antibiotic delivery systems: where are we and where are we going?. Clin Orthop Relat Res 2005; (437) 111-114
    PubMedGoogle Scholar
  • 23 Kang H, Cao J, Yu D, Zheng Z, Wang F. Comparison of 2 different techniques for anatomic reconstruction of the medial patellofemoral ligament: a prospective randomized study. Am J Sports Med 2013; 41 (05) 1013-1021
    CrossrefPubMedGoogle Scholar
  • 24 Johnson JD, Nessler JM, Horazdovsky RD, Vang S, Thomas AJ, Marston SB. Serum and wound vancomycin levels after intrawound administration in primary total joint arthroplasty. J Arthroplasty 2017; 32 (03) 924-928
    CrossrefPubMedGoogle Scholar
  • 25 Hill BW, Emohare O, Song B, Davis R, Kang MM. The use of vancomycin powder reduces surgical reoperation in posterior instrumented and noninstrumented spinal surgery. Acta Neurochir (Wien) 2014; 156 (04) 749-754
    CrossrefPubMedGoogle Scholar
  • 26 Mirzashahi B, Chehrassan M, Mortazavi SMJ. Intrawound application of vancomycin changes the responsible germ in elective spine surgery without significant effect on the rate of infection: a randomized prospective study. Musculoskelet Surg 2018; 102 (01) 35-39 . Doi: 10.1007/s12306-017-0490-z
    CrossrefPubMedGoogle Scholar
  • 27 Chotai S, Wright PW, Hale AT. , et al. Does intrawound vancomycin application during spine surgery create vancomycin-resistant organism?. Neurosurgery 2017; 80 (05) 746-753
    CrossrefPubMedGoogle Scholar
  • 28 Devin CJ, Chotai S, McGirt MJ. , et al. Intrawound vancomycin decreases the risk of surgical site infection after posterior spine surgery-a multicenter analysis. Spine 2018; 43 (01) 65-71
    CrossrefPubMedGoogle Scholar
  • 29 Dennis HH, Wei DT, Darren KZ. , et al. Is Intraoperative local vancomycin powder the answer to surgical site infections in spine surgery?. Spine 2016 ; [Epub ahead of print]
    Google Scholar
  • 30 Godil SS, Parker SL, O'Neill KR, Devin CJ, McGirt MJ. Comparative effectiveness and cost-benefit analysis of local application of vancomycin powder in posterior spinal fusion for spine trauma: clinical article. J Neurosurg Spine 2013; 19 (03) 331-335
    CrossrefPubMedGoogle Scholar
  • 31 Mariappan R, Manninen P, Massicotte EM, Bhatia A. Circulatory collapse after topical application of vancomycin powder during spine surgery. J Neurosurg Spine 2013; 19 (03) 381-383
    CrossrefPubMedGoogle Scholar
  • 32 Youssef JA, Orndorff DG, Scott MA, Ebner RE, Knewitz AP. Sterile Seroma resulting from multilevel XLIF procedure as possible adverse effect of prophylactic vancomycin powder: a case report. Evid Based Spine Care J 2014; 5 (02) 127-133
    Artikel in Thieme ConnectPubMedGoogle Scholar