Surgical Site Infection and the Use of Vancomycin Powder
A presentation at the 2015 American Association of Neurological Surgeons Annual Scientific Meeting
Article ID: 633570
Released: 3-May-2015 2:40 PM EDT
Source Newsroom: American Association of Neurological Surgeons (AANS)
Newswise — WASHINGTON, D.C. (May 4, 2015) — Winner of the DePuy Synthes Spinal Cord Injury Resident Award, Nickalus R. Khan, MD, presented his research, A Meta-analysis of Spinal Surgical Site Infection and Vancomycin Powder.
Surgical site infection (SSI) is a serious and costly complication of spinal surgery. There have been several conflicting reports on the use of intrawound vancomycin powder in decreasing SSI in spine surgery.
A comprehensive search of multiple electronic databases and bibliographies was conducted to identify clinical studies that evaluated the rates of SSI with and without the use of intrawound vancomycin powder in spine surgery. Independent reviewers extracted data and graded the quality of each paper that met inclusion criteria. A random effects meta-analysis was then performed.
The research identified eight retrospective cohort studies (level III evidence) and one randomized controlled trial (level II). There were 2,424 cases and 95 infections in the control group (3.9%) and 2,368 cases and 28 infections (1.1 percent) in the treatment group, yielding a pooled Absolute Risk Reduction (ARR) and Relative Risk Reduction (RRR) of 2.8 percent and 72 percent, respectively. The meta-analysis revealed the use of vancomycin powder to be protective in preventing SSI (RR=0.30, 95 percent CI 0.14-0.67, p<0.011). The number needed to treat (NNT) to prevent one SSI was 36. A subgroup analysis found that patients who had implants had a reduced risk of SSI with vancomycin powder (p=0.023), compared to those who had non-instrumented spinal operations (p=0.226).
This meta-analysis suggests that the use of vancomycin powder may be protective against SSI in open spinal surgery; however, the exact population in which it should be used is not clear. This benefit may be most appreciated in higher-risk populations or in facilities with a high baseline rate of infection.
Author Block: Paul Klimo, MD, FAANS; Michael Muhlbauer, MD, FAANS; Julius Fernandez, MD, FAANS; Michael DeCuypere, MD.
Disclosure: The author reported no conflicts of interest.
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Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with more than 9,000 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. Fellows of the AANS are board-certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons of Canada, or the Mexican Council of Neurological Surgery, A.C. Neurosurgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the spinal column, spinal cord, brain, nervous system and peripheral nerves.
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