Update: Vancomycin powder

Vancomycin powder

Local vancomycin powder appears to lower the risk of wound infection following lumbar laminectomy and fusion, both instrumented and non-instrumented 1).

The interpretation of the available evidence supporting the use of intrasite vancomycin powder in surgical wounds is limited, and its extrapolation should be performed with caution. Despite the lack of significant high-quality evidence available in the literature, many surgeons have adopted this practice; anecdotally it continues to provide protection from infection without apparent significant risk of side effects 2).

Debate on the effectiveness

Effectiveness

The addition of intrawound vancomycin powder in 195 consecutive posterior cervical spine surgical procedures resulted in no infections and no adverse effects 3).

Routine local application of vancomycin powder is a low-cost, effective strategy for preventing wound infection after posterior cervical fusion. 4).

The use of adjuvant vancomycin powder was associated with a significant reduction in the incidence of postoperative infection as well as infection-related medical cost. These findings suggest that use of adjuvant vancomycin powder in high-risk patients undergoing spinal fusion is a cost-saving option for preventing postoperative infections, as it can lead to cost-savings of $438,165 per 100 spinal fusions performed 5).

In the study population of Emohare et al., the cost savings totaled more than half a million dollars 6).

No effectiveness

Martin et al., 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 7)

The local application of powdered vancomycin was not associated with a significant difference in the rate of deep SSI after spinal deformity surgery, and other treatment modalities are necessary to limit infection for this high-risk group. This study is in contrary to prior studies, which have reported a decrease in SSI with vancomycin powder.Level of Evidence: 2 8)


1) Strom RG, Pacione D, Kalhorn SP, Frempong-Boadu AK. Lumbar laminectomy and fusion with routine local application of vancomycin powder: decreased infection rate in instrumented and non-instrumented cases. Clin Neurol Neurosurg. 2013 Sep;115(9):1766-9. doi: 10.1016/j.clineuro.2013.04.005. Epub 2013 Apr 23. PubMed PMID: 23622935.

2) Kang DG, Holekamp TF, Wagner SC, Lehman RA Jr. Intrasite Vancomycin Powder for the Prevention of Surgical Site Infection in Spine Surgery: A Systematic Literature Review. Spine J. 2015 Jan 27. pii: S1529-9430(15)00079-0. doi: 10.1016/j.spinee.2015.01.030. [Epub ahead of print] Review. PubMed PMID: 25637469.
3) Pahys JM, Pahys JR, Cho SK, Kang MM, Zebala LP, Hawasli AH, Sweet FA, Lee DH, Riew KD. Methods to decrease postoperative infections following posterior cervical spine surgery. J Bone Joint Surg Am. 2013 Mar 20;95(6):549-54. doi: 10.2106/JBJS.K.00756. PubMed PMID: 23515990.
4) Strom RG, Pacione D, Kalhorn SP, Frempong-Boadu AK. Decreased risk of wound infection after posterior cervical fusion with routine local application of vancomycin powder. Spine (Phila Pa 1976). 2013 Jan 15. [Epub ahead of print] PubMed PMID: 23324930.
5) Godil SS, Parker SL, O’Neill KR, Devin CJ, McGirt MJ. Comparative effectiveness and cost-benefit analysis of local application of vancomycin powder in posterior spinal fusion for spine trauma: clinical article. J Neurosurg Spine. 2013 Sep;19(3):331-5. doi: 10.3171/2013.6.SPINE121105. Epub 2013 Jul 12. PubMed PMID: 23848350.
6) Emohare O, Ledonio CG, Hill BW, Davis R, Polly DW Jr, Kang M. Cost Savings Analysis of Intra-Wound Vancomycin Powder in Posterior Spinal Surgery. Spine J. 2014 Mar 17. pii: S1529-9430(14)00252-6. doi: 10.1016/j.spinee.2014.03.011. [Epub ahead of print] PubMed PMID: 24650851.
7) Martin JR, Adogwa O, Brown CR, Kuchibhatla M, Bagley CA, Lad SP, Gottfried ON. Experience with intrawound vancomycin powder for posterior cervical fusion surgery. J Neurosurg Spine. 2014 Nov 7:1-8. [Epub ahead of print] PubMed PMID: 25380539.
8) Martin JR, Adogwa O, Brown CR, Bagley CA, Richardson WJ, Lad SP, Kuchibhatla M, Gottfried ON. Experience with intrawound vancomycin powder for spinal deformity surgery. Spine (Phila Pa 1976). 2014 Jan 15;39(2):177-84. doi: 10.1097/BRS.0000000000000071. PubMed PMID: 24158179.

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