Intrasite Vancomycin Powder for the Prevention of Surgical Site Infection in Spine Surgery: A Systematic Literature Review.

BACKGROUND CONTEXT:

Deep surgical site infections (SSIs) following spinal surgery are a significant burden to the patient, patient's family and the healthcare system. Due to increasing pressures to reduce SSIs and control costs, some spine surgeons have begun placing lyophilized vancomycin powder directly into the surgical wound at the conclusion of the procedure. However, the literature supporting this practice remains limited.

PURPOSE:

To review the current literature examining the use of prophylactic intrasite vancomycin powder to control SSIs in spinal surgery, and determine if any standard recommendations can be made.

STUDY DESIGN/SETTING:

Systematic review.

METHODS:

Ovid MEDLINE and PubMed were searched to identify English language articles.

RESULTS:

No current guidelines are available for the use of intrasite vancomycin powder in preventing surgical site infections, and no standard dosage for the drug exists. Based on the limited literature currently available, there appears to be a protective effect of intrasite vancomycin powder on the incidence of SSI without evidence of significant risk of side effects, but the evidence is limited. However, case reports do exist describing systemic side effects following intrasite vancomycin powder during spine surgery.

CONCLUSIONS:

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.