title: Is Intraoperative Local Vancomycin Powder the Answer to Surgical Site Infections in Spine Surgery?
abstract: METHODS
  This is a retrospective cohort comparative study of all patients who underwent instrumented spine surgery at a single institution.
  
  
  OBJECTIVE
  To compare the rate of surgical site infection (SSI) between the treatment (vancomycin) and the control group (no vancomycin) in patients undergoing instrumented spine surgery.
  
  
  BACKGROUND
  SSI after spine surgery is a dreaded complication associated with increased morbidity and mortality. Prophylactic intraoperative local vancomycin powder to the wound has been recently adopted as a strategy to reduce SSI but results have been variable.
  
  
  METHODS
  In the present study, there were 117 (30%) patients in the treatment group and 272 (70%) patients in the comparison cohort. All patients received identical standard operative and postoperative care procedures based on protocolized department guidelines. The present study compared the rate of SSI with and without the use of prophylactic intraoperative local vancomycin powder in patients undergoing various instrumented spine surgery, adjusted for confounders.
  
  
  RESULTS
  The overall rate of SSI was 4.7% with a decrease in infection rate found in the treatment group (0.9% vs. 6.3%). This was statistically significant (P = 0.049) with an odds ratio of 0.13 (95% confidence interval 0.02-0.99). The treatment group had a significantly shorter onset of infection (5 vs. 16.7 days; P < 0.001) and shorter duration of infection (8.5 vs. 26.8 days; P < 0.001). The most common causative organism was Pseudomonas aeruginosa (35.2%). Patient diagnosis, surgical approach, and intraoperative blood loss were significant risk factors for SSI after multivariable analysis.
  
  
  CONCLUSIONS
  Prophylactic Intraoperative local vancomycin powder reduces the risk and morbidity of SSI in patients undergoing instrumented spine surgery. P. aeruginosa infection is common in the treatment arm. Future prospective randomized controlled trials in larger populations involving other spine surgeries with a long-term follow-up duration are recommended.
  
  
  METHODS
  3.
authors.affiliation: Department of Orthopaedic Surgery, National University Hospital, Singapore, Singapore.
authors.forename: Hwee Weng Dennis
authors.initials: HWD
authors.lastname: Hey
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
authors.forename: Desmond Wei
authors.initials: DW
authors.lastname: Thiam
authors.affiliation: Department of Orthopaedic Surgery, National University Hospital, Singapore, Singapore.
authors.forename: Zhi Seng Darren
authors.initials: ZSD
authors.lastname: Koh
authors.affiliation: Department of Orthopaedic Surgery, National University Hospital, Singapore, Singapore.
authors.forename: Joseph Shantakumar
authors.initials: JS
authors.lastname: Thambiah
authors.affiliation: Department of Orthopaedic Surgery, National University Hospital, Singapore, Singapore.
authors.forename: Naresh
authors.initials: N
authors.lastname: Kumar
authors.affiliation: Department of Orthopaedic Surgery, National University Hospital, Singapore, Singapore.
authors.forename: Leok-Lim
authors.initials: LL
authors.lastname: Lau
authors.affiliation: Department of Orthopaedic Surgery, National University Hospital, Singapore, Singapore.
authors.forename: Ka-Po Gabriel
authors.initials: KG
authors.lastname: Liu
authors.affiliation: Department of Orthopaedic Surgery, National University Hospital, Singapore, Singapore.
authors.forename: Hee-Kit
authors.initials: HK
authors.lastname: Wong
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011208:Powders; D011247:Pregnancy; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods; D013131:Spine / Q000601:surgery*; D013530:Surgical Wound Infection / Q000188:drug therapy*; D016896:Treatment Outcome; D014640:Vancomycin / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D011208:Powders; D014640:Vancomycin