title: Effect of Using Local Intrawound Vancomycin Powder in Addition to Intravenous Antibiotics in Posterior Lumbar Surgery: Midterm Result in a Single-Center Study.
abstract: OBJECTIVE
  We conducted this study to report the efficacy of local application of vancomycin powder in the setting of surgical site infection (SSI) of posterior lumbar surgical procedures and to figure out risk factors of SSIs.
  
  
  METHODS
  From February 2013 to December 2013, SSI rates following 275 posterior lumbar surgeries of which intrawound vancomycin powder was used in combination with intravenous antibiotics (Vanco group) were assessed. Compared with 296 posterior lumbar procedures with intravenous antibiotic only group from February 2012 to December 2012 (non-Vanco group), various infection rates were assessed. Univariate and multivariate analysis to figure out risk factors of infection among Vanco group were done.
  
  
  RESULTS
  Statistically significant reduction of SSI in Vanco group (5.5%) from non-Vanco group (10.5%) was confirmed (p=0.028). Mean follow-up period was 8 months. Rate of acute staphylococcal SSIs reduced statistically significantly to 4% compared to 7.4% of non-Vanco group (p=0.041). Deep staphylococcal infection decreased to 2 compared to 8 and deep methicillin-resistant Staphylococcus aureus infection also decreased to 1 compared to 5 in non-Vanco group. No systemic complication was observed. Statistically significant risk factors associated with SSI were diabetes mellitus, history of cardiovascular disease, length of hospital stay, number of instrumented level and history of previous surgery.
  
  
  CONCLUSIONS
  In this series of 571 patients, intrawound vancomycin powder usage resulted in significant decrease in SSI rates in our posterior lumbar surgical procedures. Patients at high risk of infection are highly recommended as a candidate for this technique.
authors.affiliation: Department of Neurosurgery, Hanyang University Medical Center, Hanyang University College of Medicine, Seoul, Korea.
authors.forename: Gun-Ill
authors.initials: GI
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, Hanyang University Medical Center, Hanyang University College of Medicine, Seoul, Korea.
authors.forename: Koang Hum
authors.initials: KH
authors.lastname: Bak
authors.affiliation: Department of Neurosurgery, Hanyang University Medical Center, Hanyang University College of Medicine, Seoul, Korea.
authors.forename: Hyoung-Joon
authors.initials: HJ
authors.lastname: Chun
authors.affiliation: Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Kyu-Sun
authors.initials: KS
authors.lastname: Choi
keywords: Staphylococcal infection; Surgical wound infection; Topical administration; Vancomycin