Effectiveness of Topical Vancomycin in the Prevention of Spinal Surgical Site Infections: A Retrospective Cohort Study

Abstract BackgroundThe risk of surgical site infections (SSIs), particularly methicillin-resistant staphylococcus aureus (MRSA) SSIs, post spinal surgeries is one of the most daunting experiences to patients and surgeons. In some practices, vancomycin powder is applied directly 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 the Kingdom Hospital (a private Saudi hospital).MethodsA 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 to 30 days (surgeries without implantation) or 90 days (with implantation). The odds ratio (OR) of the primary outcome between vancomycin users vs. non-users was estimated using logistic regression 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.ResultsWe included 81 vancomycin users vs. 375 non-users with 28 infections. 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]). ConclusionWe 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.