title: The use of local vancomycin powder in degenerative spine surgery.
abstract: OBJECTIVE
  Wound infection after spine surgery is a debilitating complication. Local placement of vancomycin powder into the surgical wounds prior to closing of the fascia has been introduced as a method to reduce deep infection rates.
  
  
  METHODS
  The infection rates of all the patients who were treated with intra-operative local vancomycin between June 2012 and June 2013 were compared to all cases that were not treated with vancomycin between January 2009 and December 2010. Patients for both groups were operated by four senior, fellowship-trained spine surgeons with a combined experience of 55 years of practice at a referral orthopedic center. Patients' charts and microbiology reports were reviewed.
  
  
  RESULTS
  1224 cases were performed with the use of vancomycin. The average age was 56.3 years (SD -13.2; NS). The male to female ratio was 1:1.12 (NS). 2253 cases were performed without the use of vancomycin. The average patient age was 57.1 years (SD 14.5). The male to female ratio was 1:1.14. There were 30 cases of deep infections needing a surgical irrigation and debridement without vancomycin versus 5 when vancomycin was used (P = 0.04). Infections in patients treated with vancomycin were not vancomycin-resistant bacteria.
  
  
  CONCLUSIONS
  In conclusion, the use of vancomycin reduces the rate of deep wound infections and irrigation and debridement procedures after spine surgery in a referral center among surgeons with a high surgical volume.
authors.affiliation: Spine Surgery, Hospital for Special Surgery, 525 East 70 St, New York, NY, 10021, USA. schroeder.josh@gmail.com.
authors.forename: Josh E
authors.initials: JE
authors.lastname: Schroeder
authors.affiliation: Spine Surgery, Hospital for Special Surgery, 525 East 70 St, New York, NY, 10021, USA.
authors.forename: Fredrico P
authors.initials: FP
authors.lastname: Girardi
authors.affiliation: Spine Surgery, Hospital for Special Surgery, 525 East 70 St, New York, NY, 10021, USA.
authors.forename: Harvinder
authors.initials: H
authors.lastname: Sandhu
authors.affiliation: Spine Surgery, Hospital for Special Surgery, 525 East 70 St, New York, NY, 10021, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Weinstein
authors.affiliation: Spine Surgery, Hospital for Special Surgery, 525 East 70 St, New York, NY, 10021, USA.
authors.forename: Frank P
authors.initials: FP
authors.lastname: Cammisa
authors.affiliation: Spine Surgery, Hospital for Special Surgery, 525 East 70 St, New York, NY, 10021, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Sama
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D003646:Debridement; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures; D013122:Spinal Diseases / Q000601:surgery; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control*; D014640:Vancomycin / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin
keywords: Deep infection; Degenerative spine disease; Irrigation and debridement; Vancomycin