Local Application of Vancomycin in Spine Surgery Does Not Result in Increased Vancomycin-Resistant Bacteria-10-Year Data.
Administration, Topical
Anti-Bacterial Agents
/ administration & dosage
Antibiotic Prophylaxis
/ adverse effects
Bacteria
/ drug effects
Bacterial Infections
/ epidemiology
Case-Control Studies
Female
Humans
Male
Middle Aged
Retrospective Studies
Spinal Fusion
/ adverse effects
Spine
/ surgery
Surgical Wound Infection
/ epidemiology
Vancomycin
/ administration & dosage
Vancomycin Resistance
Gram-negative infections
Intrawound application of vancomycin
Polymicrobial infections
Surgical site infection
Vancomycin-resistant infections
Journal
Spine deformity
ISSN: 2212-1358
Titre abrégé: Spine Deform
Pays: England
ID NLM: 101603979
Informations de publication
Date de publication:
09 2019
09 2019
Historique:
received:
01
04
2018
revised:
19
01
2019
accepted:
26
01
2019
entrez:
10
9
2019
pubmed:
10
9
2019
medline:
28
4
2020
Statut:
ppublish
Résumé
Case-control study. To analyze the microbial flora in surgical spine infections and their antibiotic resistance patterns across time and determine the correlation between vancomycin application in the wound and vancomycin-resistant microbes. Prior studies show a reduction in surgical site infections with intrawound vancomycin placement. No data are available on the potential negative effects of this intervention, in particular, whether there would be a resultant increase in vancomycin-resistant organisms or bacterial resistance profiles. All culture-positive surgical site infections at a single institution were analyzed from 2007 to 2017. Each bacterium was assessed independently for resistance patterns. The two-tailed Fisher exact test was used to determine the correlation between vancomycin application and the presence of vancomycin-resistant bacteria, polymicrobial infections, or gram-negative bacterial infections. One hundred and eight bacteria were isolated from 113 surgical site infections from 2007 to 2017. The most common organisms were staphylococcus with varying resistance patterns and Escherichia coli. Vancomycin-resistant Enterococcus faecium was isolated in three infections. Out of the 4,878 surgical cases from 2011 to 2017, vancomycin was placed in 48.3%, and no vancomycin in 51.7%. There were 33 infections (1.4%) in the vancomycin group and 20 infections (0.8%) in the no-vancomycin group (χ Topical vancomycin within the surgical site is not correlated with vancomycin-resistant bacteria. However, there was an increased incidence of gram-negative organisms in infections after vancomycin application in the wound versus no vancomycin. Continued surveillance with prospectively collected randomized data is necessary to better understand bacterial evolution against current antimicrobial techniques. Level III.
Sections du résumé
STUDY DESIGN
Case-control study.
OBJECTIVES
To analyze the microbial flora in surgical spine infections and their antibiotic resistance patterns across time and determine the correlation between vancomycin application in the wound and vancomycin-resistant microbes.
SUMMARY OF BACKGROUND DATA
Prior studies show a reduction in surgical site infections with intrawound vancomycin placement. No data are available on the potential negative effects of this intervention, in particular, whether there would be a resultant increase in vancomycin-resistant organisms or bacterial resistance profiles.
METHODS
All culture-positive surgical site infections at a single institution were analyzed from 2007 to 2017. Each bacterium was assessed independently for resistance patterns. The two-tailed Fisher exact test was used to determine the correlation between vancomycin application and the presence of vancomycin-resistant bacteria, polymicrobial infections, or gram-negative bacterial infections.
RESULTS
One hundred and eight bacteria were isolated from 113 surgical site infections from 2007 to 2017. The most common organisms were staphylococcus with varying resistance patterns and Escherichia coli. Vancomycin-resistant Enterococcus faecium was isolated in three infections. Out of the 4,878 surgical cases from 2011 to 2017, vancomycin was placed in 48.3%, and no vancomycin in 51.7%. There were 33 infections (1.4%) in the vancomycin group and 20 infections (0.8%) in the no-vancomycin group (χ
CONCLUSIONS
Topical vancomycin within the surgical site is not correlated with vancomycin-resistant bacteria. However, there was an increased incidence of gram-negative organisms in infections after vancomycin application in the wound versus no vancomycin. Continued surveillance with prospectively collected randomized data is necessary to better understand bacterial evolution against current antimicrobial techniques.
LEVEL OF EVIDENCE
Level III.
Identifiants
pubmed: 31495468
pii: S2212-134X(19)30021-8
doi: 10.1016/j.jspd.2019.01.005
pii:
doi:
Substances chimiques
Anti-Bacterial Agents
0
Vancomycin
6Q205EH1VU
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
696-701Informations de copyright
Copyright © 2019 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.