title: Safety of topical vancomycin for pediatric spinal deformity: nontoxic serum levels with supratherapeutic drain levels.
abstract: METHODS
  Retrospective cohort analysis.
  
  
  OBJECTIVE
  To establish if drain levels exceed the minimum inhibitory concentrations for common pathogens (methicillin-resistant Staphylococcus aureus, methicillin-sensitive Staphylococcus aureus, and Propionibacterium acnes-2 μg/mL; Staphylococcus epidermidis, Enterococcus faecalis-4 μg/mL). Evaluate the safety of topical vancomycin in pediatric patients undergoing spinal deformity surgery and determine if postoperative serum levels approach toxicity (25 μg/mL).
  
  
  BACKGROUND
  The application of topical vancomycin powder has decreased postoperative wound infections in retrospective analyses in the adult population with minimal local and systemic risks. The safety and efficacy of vancomycin powder has not been completely evaluated in the pediatric population after deformity surgery.
  
  
  METHODS
  Topical vancomycin powder (1 g) was applied during wound closure after instrumented posterior spinal fusion. All patients received intravenous perioperative antibiotics and a subfascial drain was used. Serum and drain vancomycin levels were collected immediately postoperatively and during the first 2 postoperative days (PODs). Complications were recorded.
  
  
  RESULTS
  The study population consisted of 25 patients with a mean age of 13.5 years (9.5-17.1 yr) and mean ± standard deviation body weight of 44.5 ± 18 kg. Underlying diagnoses included: adolescent idiopathic scoliosis (12), neuromuscular scoliosis (10), and kyphosis (3). Mean serum vancomycin levels trended downward from 2.5 μg/mL (POD 0) to 1.9 μg/mL (POD 1) to 1.1 μg/mL (POD 2). Mean drain levels also trended downward from 403 μg/mL (POD 0) to 251 μg/mL (POD 1) to 115 μg/mL (POD 2). No vancomycin toxicity or deep wound infections were observed. One patient with neuromuscular scoliosis developed a superficial wound dehiscence that was managed with dressing changes.
  
  
  CONCLUSIONS
  Topical application of vancomycin powder in pediatric spinal deformity surgery produced local levels well above the minimum inhibitory concentration for common pathogens and serum levels below the toxicity threshold (25 μg/mL). There were no deep wound or antibiotic related complications.
  
  
  METHODS
  3.
authors.affiliation: From the Department of Orthopaedics, Vanderbilt Children's Hospital, Monroe Carell Jr. Children's Hospital, Nashville, TN.
authors.forename: Sheyan J
authors.initials: SJ
authors.lastname: Armaghani
authors.forename: Travis J
authors.initials: TJ
authors.lastname: Menge
authors.forename: Steven A
authors.initials: SA
authors.lastname: Lovejoy
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Mencio
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Martus
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy / Q000517:prevention & control*; D002648:Child; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D011208:Powders; D012189:Retrospective Studies; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome; D014640:Vancomycin / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D011208:Powders; D014640:Vancomycin