Abstract
Abstract
Background
The risk of surgical site infections (SSIs), particularly methicillin-resistant Staphylococcus aureus (MRSA) SSIs, after spinal surgeries is one of the most daunting experiences to patients and surgeons. Some authors suggest applying vancomycin powder on the wound before skin closure to minimize the risk of SSIs; however, this practice is not supported by well-established evidence. This study sought to assess the effectiveness of topical (i.e. intra-wound) vancomycin in minimizing the risk of SSIs in patients who underwent spinal surgeries at a Saudi hospital.
Methods
A retrospective cohort study was conducted using the hospital database. Patients who underwent spinal surgeries from the period of 09/2013 to 09/2019 were included and followed up (observed from the time of the surgery) to 30 days (surgeries without implants) or 90 days (with implants). The odds ratio (OR) of the primary outcome between vancomycin treated versus non-treated patients was estimated using a logistic regression model adjusting for the measured confounders. A sensitivity analysis was conducted using propensity score analysis (inverse probability of treatment weighting [IPTW] with stabilized weights) to control for confounding by indication. All study analyses were completed using RStudio Version 1.2.5033.
Results
We included 81 vancomycin treated vs. 375 untreated patients with 28 infections (8/81 vs. 20/375; respectively). The adjusted OR of SSIs between the two groups was 0.40 (95% confidence interval [CI] 0.11 to 1.34). The result of the propensity score analysis was consistent (OR: 0.97 [95% CI 0.35 to 2.68]).
Conclusions
We could not find a lower association of SSIs with intra-wound vancomycin in patients who underwent spinal surgeries. Further studies are needed to assess benefits of using topical vancomycin for this indication vs. the risk of antimicrobial resistance.
Publisher
Springer Science and Business Media LLC
Subject
Pharmacology (medical),Infectious Diseases,Microbiology (medical),Public Health, Environmental and Occupational Health
Reference64 articles.
1. Jiaming Z, Wang R. Incidence of surgical site infection after spine surgery: a systematic review and meta-analysis. SPINE. 2019;45(3):208-16.
2. The French Orthopaedic Surgery Traumatology Society. Early surgical site infections in adult spinal trauma: a prospective, multi-center study of infection rates and risk factors. Orthop Traumatol Surg Res. 2012;98:788–94.
3. Saeedinia S, Nouri M, Azarhomayoun A, et al. The incidence and risk factors for surgical site infection after clean spinal operations: a prospective cohort study and review of the literature. Surg Neurol Int. 2015;6:154.
4. World Health Organization WHO. Protocol for surgical site infection surveillance with a focus on settings with limited resources. 2018.
5. Anderson PA, Savage JW, Vaccaro AR, et al. Prevention of surgical site infection in spine surgery. Neurosurgery. 2017;80(3S):S114–23.
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