title: Intrasite vancomycin powder for the prevention of surgical site infection in spine surgery: a systematic literature review.
abstract: BACKGROUND
  Deep surgical site infections (SSIs) following spinal surgery are a significant burden to the patient, patient's family, and the health-care system. Because of increasing pressures to reduce SSIs and control costs, some spine surgeons have begun placing lyophilized vancomycin powder directly into the surgical wound at the conclusion of the procedure. However, the literature supporting this practice remains limited.
  
  
  OBJECTIVE
  To review the current literature examining the use of prophylactic intrasite vancomycin powder to control SSIs in spinal surgery and determine if any standard recommendations can be made.
  
  
  METHODS
  A systematic review.
  
  
  METHODS
  Ovid Medline and PubMed were searched to identify English language articles.
  
  
  RESULTS
  No current guidelines are available for the use of intrasite vancomycin powder in preventing SSIs, and no standard dosage for the drug exists. Based on the limited literature and evidence currently available, there appears to be a protective effect of intrasite vancomycin powder on the incidence of SSI, without evidence of side effects. However, case reports do exist describing the systemic side effects after intrasite vancomycin powder during spine surgery.
  
  
  CONCLUSIONS
  The interpretation of the available evidence supporting the use of intrasite vancomycin powder in surgical wounds is limited, and its extrapolation should be performed with caution. Despite the lack of significant high-quality evidence available in the literature, many surgeons have adopted this practice; anecdotally, it continues to provide protection from infection without apparent significant risk of side effects.
authors: Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, 8901 Wisconsin Ave., Bldg 19, Rm #2101, Bethesda, MD 20889, USA. Electronic address: daniel.g.kang@gmail.com.
authors: Daniel G
authors: DG
authors: Kang
authors: Department of Neurosurgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8057, St. Louis, MO 63110, USA.
authors: Terrence F
authors: TF
authors: Holekamp
authors: Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, 8901 Wisconsin Ave., Bldg 19, Rm #2101, Bethesda, MD 20889, USA.
authors: Scott C
authors: SC
authors: Wagner
authors: Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, 8901 Wisconsin Ave., Bldg 19, Rm #2101, Bethesda, MD 20889, USA; Division of Orthopaedics, Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
authors: Ronald A
authors: RA
authors: Lehman
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D006801:Humans; D013123:Spinal Fusion / Q000379:methods*; D013131:Spine / Q000601:surgery*; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000517:prevention & control*; D014640:Vancomycin / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin
keywords: Antibiotic prophylaxis; Intrasite vancomcyin powder; Spinal deformity surgery; Spine surgery; Surgical site infection; Topical vancomycin powder; Vancomycin powder