Experience with intrawound vancomycin powder for posterior cervical fusion surgery.
OBJECTIVE
Recent studies have reported that the local delivery of vancomycin powder is associated with a decrease in spinal surgical site infection. This retrospective cohort study compares posterior cervical fusion cases before and after the routine application of spinal vancomycin powder to evaluate the ability of local vancomycin powder to prevent deep wound infection after posterior cervical spinal fusion.


METHODS
Posterior cervical fusion spinal surgeries performed at a single institution were reviewed from January 2011 to July 2013. Each cohort's baseline characteristics, operative data, and rates of wound infection were compared. Associations between infection and vancomycin powder, with and without propensity score adjustment for risk factors, were determined using logistic regression.


RESULTS
A total of 289 patients (174 untreated and 115 treated with vancomycin powder) were included in the study. The cohorts were similar in terms of baseline and operative variables. No significant change in deep wound infection rate was seen between the control group (6.9%) and intervention group (5.2%, p = 0.563). Logistic regression, with and without propensity score adjustment, demonstrated that the use of vancomycin powder did not impact the development of surgical site infection (OR 0.743 [95% CI 0.270-2.04], p = 0.564) and (OR 0.583 [95% CI 0.198-1.718], p = 0.328), respectively.


CONCLUSIONS
Within the context of an ongoing debate on the effectiveness of locally administered vancomycin powder, the authors found no significant difference in the incidence of deep wound infection rates after posterior cervical fusion surgery with routine use of locally applied vancomycin powder. Future prospective randomized series are needed to corroborate these results.
Division of Neurosurgery, Department of Surgery;
Joel R
JR
Martin
Owoicho
O
Adogwa
Christopher R
CR
Brown
Maragatha
M
Kuchibhatla
Carlos A
CA
Bagley
Shivanand P
SP
Lad
Oren N
ON
Gottfried
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D019072:Antibiotic Prophylaxis / Q000379:methods*; D002574:Cervical Vertebrae / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011208:Powders / Q000008:administration & dosage; D012189:Retrospective Studies; D012307:Risk Factors; D013123:Spinal Fusion / Q000009:adverse effects*; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control*; D014640:Vancomycin / Q000008:administration & dosage*
D000900:Anti-Bacterial Agents; D011208:Powders; D014640:Vancomycin
BMI = body mass index; CDC = Centers for Disease Control and Prevention; COPD = chronic obstructive pulmonary disease; CTJ = cervicothoracic junction; EBL = estimated blood loss; MRSA = methicillin-resistant Staphylococcus aureus; SSI = surgical site infection; cervical fusion; local anti-infective agents; spinal fusion; spinal stenosis; treatment outcome; vancomycin; wound infection