Safety and efﬁcacy of intrawound vancomycin powder in the prevention of lumbar surgical site infection: a prospective, double-blind, randomized controlled study

International Journal of Surgery, 2025 · DOI: http://dx.doi.org/10.1097/JS9.0000000000001846 · Published: June 24, 2024

Simple Explanation

Surgical site infections (SSIs) are a significant problem after spine surgery, leading to increased costs and longer hospital stays. This study investigates whether using vancomycin powder directly in the wound during surgery can reduce these infections. The study compared patients receiving vancomycin powder in the wound to a control group receiving only standard intravenous antibiotics. Researchers looked at infection rates and any adverse reactions to vancomycin. The results showed that vancomycin powder significantly reduced SSI rates without causing adverse reactions. This suggests it's a safe and effective way to prevent infections after PLIF surgery.

Study Duration

May 2021 to September 2022

Participants

156 patients undergoing posterior lumbar interbody fusion (PLIF)

Evidence Level

Level 1: Prospective, double-blind, randomized controlled study

Key Findings

1
The study found an 87.5% decrease in the surgical site infection (SSI) rate in the vancomycin group compared to the control group.
2
No vancomycin-related adverse reactions were observed during the 90-day follow-up period.
3
The vancomycin group demonstrated a statistically significant decrease in serum ESR on POD 3 (P = 0.039) and CRP on POD 5 (P = 0.024) compared to the control group.

Research Summary

This prospective, double-blind, randomized controlled study evaluated the safety and efficacy of intrawound vancomycin powder in preventing surgical site infections (SSIs) after posterior lumbar interbody fusion (PLIF) surgery. The study found that intrawound application of vancomycin powder significantly reduced the SSI rate compared to intravenous prophylactic antibiotics alone, without any observed vancomycin-related adverse effects. The authors concluded that intrawound vancomycin powder is a safe and effective method for reducing the risk of SSIs in patients undergoing PLIF surgery, delivering a high concentration of the antibiotic directly to the surgical site while minimizing systemic absorption.

Practical Implications

Reduced SSI Risk

Intrawound vancomycin powder can be used to significantly reduce the risk of surgical site infections following PLIF surgery.

Safe Application

The application of vancomycin powder directly into the surgical wound appears to be safe, with no observed vancomycin-related adverse effects in the study.

Targeted Antibiotic Delivery

Intrawound application allows for high local concentrations of antibiotics at the surgical site while minimizing systemic exposure.

Study Limitations

1
The reduction in SSIs pertained specifically to superficial infections, while vancomycin was applied to deep soft tissues.
2
The causative organisms isolated included gram-negative bacteria against which vancomycin has no antimicrobial activity.
3
The investigation was limited by its 90-day follow-up duration, which is insufficient for observing long-term complications.

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