title: An intraoperative irrigation regimen to reduce the surgical site infection rate following adolescent idiopathic scoliosis surgery.
abstract: BACKGROUND
  The aim of this study was to compare the efficacy of a gentamicin antibiotic intraoperative irrigation regimen (regimen A) with a povidone-iodine intraoperative irrigation regimen (regimen B) and to evaluate the ability of adjunctive local vancomycin powder (regimen C) to reduce the surgical site infection (SSI) rate following idiopathic scoliosis correction.
  
  
  METHODS
  This was a retrospective, single centre, two-surgeon cohort study of paediatric scoliosis procedures involving 118 patients under the age of 18 years who underwent correction for idiopathic scoliosis over a period of 42 months. Patients' baseline characteristics, pseudarthrosis and rates of SSI were compared.
  
  
  RESULTS
  Baseline characteristics were comparable in all three groups, with the exception of sex distribution. Over a quarter (27%) of patients with regimen B were male compared with 13% and 6% for regimens A and C respectively. Patients were mostly followed up for a minimum of 12 months. The SSI rate for both superficial and deep infections was higher with regimen A (26.7%) than with regimens B and C (7.0% and 6.3% respectively). The SSI rates for regimens B and C were comparable. No patients developed complications related to vancomycin toxicity, metalwork failure or pseudarthrosis.
  
  
  CONCLUSIONS
  Wound irrigation with a povidone-iodine solution reduces SSIs following adolescent idiopathic scoliosis surgery. The direct application of vancomycin powder to the wound is safe but does not reduce the SSI rate further in low risk patients. Additional studies are needed to elucidate whether it is effective at higher doses and in high risk patient groups.
authors.affiliation: University Hospital Southampton NHS Foundation Trust , UK.
authors.forename: B
authors.initials: B
authors.lastname: van Herwijnen
authors.affiliation: University Hospital Southampton NHS Foundation Trust , UK.
authors.forename: N R
authors.initials: NR
authors.lastname: Evans
authors.affiliation: University Hospital Southampton NHS Foundation Trust , UK.
authors.forename: C J
authors.initials: CJ
authors.lastname: Dare
authors.affiliation: University Hospital Southampton NHS Foundation Trust , UK.
authors.forename: E M
authors.initials: EM
authors.lastname: Davies
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007430:Intraoperative Care / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D011206:Povidone-Iodine / Q000008:administration & dosage / Q000627:therapeutic use; D012189:Retrospective Studies; D012600:Scoliosis / Q000601:surgery*; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control*; D007507:Therapeutic Irrigation / Q000379:methods* / Q000706:statistics & numerical data*; D014640:Vancomycin / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins; D014640:Vancomycin; D011206:Povidone-Iodine
keywords: Antibiotic; Infection; Iodine; Paediatric; Scoliosis