Experience with intrawound vancomycin powder for posterior cervical fusion surgery.
OBJECT
Recent studies have reported that the local delivery of vancomycin powder is associated with a decrease in spinal surgical site infection. This retrospective cohort study compares posterior cervical fusion cases before and after the routine application of spinal vancomycin powder to evaluate the ability of local vancomycin powder to prevent deep wound infection after posterior cervical spinal fusion.


METHODS
Posterior cervical fusion spinal surgeries performed at a single institution were reviewed from January 2011 to July 2013. Each cohort's baseline characteristics, operative data, and rates of wound infection were compared. Associations between infection and vancomycin powder, with and without propensity score adjustment for risk factors, were determined using logistic regression.


RESULTS
A total of 289 patients (174 untreated and 115 treated with vancomycin powder) were included in the study. The cohorts were similar in terms of baseline and operative variables. No significant change in deep wound infection rate was seen between the control group (6.9%) and intervention group (5.2%, p = 0.563). Logistic regression, with and without propensity score adjustment, demonstrated that the use of vancomycin powder did not impact the development of surgical site infection (OR 0.743 [95% CI 0.270-2.04], p = 0.564) and (OR 0.583 [95% CI 0.198-1.718], p = 0.328), respectively.


CONCLUSIONS
Within the context of an ongoing debate on the effectiveness of locally administered vancomycin powder, the authors found no significant difference in the incidence of deep wound infection rates after posterior cervical fusion surgery with routine use of locally applied vancomycin powder. Future prospective randomized series are needed to corroborate these results.
['Martin|Joel R|JR|', 'Adogwa|Owoicho|O|', 'Brown|Christopher R|CR|', 'Kuchibhatla|Maragatha|M|', 'Bagley|Carlos A|CA|', 'Lad|Shivanand P|SP|', 'Gottfried|Oren N|ON|']
D000328:Adult D000368:Aged D000900:Anti-Bacterial Agents D019072:Antibiotic Prophylaxis D002574:Cervical Vertebrae D005260:Female D006801:Humans D015994:Incidence D017053:Infection Control D016015:Logistic Models D008297:Male D008875:Middle Aged D011208:Powders D012189:Retrospective Studies D012307:Risk Factors D013123:Spinal Fusion D013530:Surgical Wound Infection D014640:Vancomycin
vancomycin cervical fusion wound infection spinal fusion BMI = body mass index CDC = Centers for Disease Control and Prevention COPD = chronic obstructive pulmonary disease CTJ = cervicothoracic junction EBL = estimated blood loss MRSA = methicillin-resistant Staphylococcus aureus SSI = surgical site infection local anti-infective agents spinal stenosis treatment outcome