Intraoperative vancomycin use in spinal surgery: single institution experience and microbial trends.
METHODS
Retrospective case series.


OBJECTIVE
To demonstrate the microbial trends of spinal surgical site infections in patients who had previously received crystallized vancomycin in the operative bed.


BACKGROUND
Prior large, case control series demonstrate the significant decrease in surgical site infection with the administration of vancomycin in the wound bed.


METHODS
A single institution, electronic database search was conducted for all patients who underwent spinal surgery who had received prophylactic crystalline vancomycin powder in the wound bed. Patients with a prior history of wound infection, intrathecal pumps, or spinal stimulators were excluded.


RESULTS
A total of 981 consecutive patients (494 males, 487 females; mean age, 59.4 yr; range, 16-95 yr) were identified from January 2011 to June 2013. The average dose of vancomycin powder was 1.13 g (range, 1-6 g). Sixty-six patients (6.71%) were diagnosed with a surgical site infection, of which 51 patients had positive wound cultures (5.2%). Of the 51 positive cultures, the most common organism was Staphylococcus aureus. The average dose of vancomycin was 1.3 g in the 38 cases where a gram-positive organism was cultured. A number of gram-negative infections were encountered such as Serratia marcescens, Enterobacter aerogenes, Bacteroides fragilis, Enterobacter cloacae, Citrobacter koseri, and Pseudomonas aeruginosa. The average dose of vancomycin was 1.2 g in 23 cases where a gram-negative infection was cultured. Fifteen of the 51 positive cultures (29.4%) were polymicrobial. Eight (53%) of these 15 polymicrobial cultures contained 3 or more distinct organisms.


CONCLUSIONS
Prophylactic intraoperative vancomycin use in the wound bed in spinal surgery may increase the incidence of gram-negative or polymicrobial spinal infections. The use of intraoperative vancomycin may correlate with postoperative seromas, due to the high incidence of nonpositive cultures. Large, randomized, prospective trials are needed to demonstrate causation and dose-response relationship.
*Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA; and †Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, AZ.
George M
GM
Ghobrial
Vismay
V
Thakkar
Edward
E
Andrews
Michael
M
Lang
Ameet
A
Chitale
Mark E
ME
Oppenlander
Christopher M
CM
Maulucci
Ashwini D
AD
Sharan
Joshua
J
Heller
James S
JS
Harrop
Jack
J
Jallo
Srinivas
S
Prasad
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects; D013530:Surgical Wound Infection / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D016896:Treatment Outcome; D014640:Vancomycin / Q000627:therapeutic use*; D055815:Young Adult
D000900:Anti-Bacterial Agents; D014640:Vancomycin