Effect of Intra-wound Vancomycin for Spinal Surgery: A Systematic Review and Meta-analysis

被引:27
作者
Xie, Lun-li [1 ,2 ]
Zhu, Jun [1 ,2 ]
Yang, Mao-sheng [2 ]
Yang, Chang-yuan [1 ]
Luo, Shun-hong [1 ]
Xie, Yu [1 ,2 ]
Pu, Dan [1 ,2 ]
机构
[1] Jishou Univ, Affiliated Hosp 4, Peoples Hosp Huaihua 1, Rehabil Med Ctr,Dept Minimally Invas Orthopaed, Huaihua, Peoples R China
[2] Jishou Univ, Sch Med, Res Ctr Translat Med, Jishou, Peoples R China
关键词
Dose-dependent effects; Intra-wound vancomycin; Method of administration; Spinal surgery; Wound infection; SURGICAL SITE INFECTIONS; POSTERIOR CERVICAL FUSION; ROUTINE LOCAL APPLICATION; TOPICAL VANCOMYCIN; POWDER DECREASES; EXPERIENCE; ANTIBIOTICS; RISK; THERAPY; HEALTH;
D O I
10.1111/os.12356
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Intra-site prophylactic vancomycin in spine surgery is an effective method of decreasing the incidence of postsurgical wound infection. However, there are differences in the prophylactic programs used for various spinal surgeries. Thus, this systematic review and meta-analysis aimed to evaluate the effectiveness of using intra-wound vancomycin during spinal surgery and to explore the effects of dose-dependence and the method of administration in a subgroup analysis. A total of 628 citations or studies were searched in PubMed, Ovid, Web of Science, and Google Scholar that were published before August 2016 with the terms local vancomycin, intra-wound vancomycin, intraoperative vancomycin, intra-site vancomycin, topical vancomycin, spine surgery, and spinal surgery. Finally, 19 retrospective cohort studies and one prospective case study were eligible for inclusion in the systematic review and meta-analysis. The odds of developing postsurgical wound infection without prophylactic local vancomycin use were 2.83-fold higher than the odds of experiencing wound infection with the use of intra-wound vancomycin (95% confidence interval, 2.03-3.95; P = 0.083; I-2 = 32.2%). The subgroup analysis including the dosage and the method of administration, revealed different results compared to previous research. The value of I-2 in the 1-g group was 27.2%, which was much lower than in the 2-g group (I-2 = 57.6%). At the same time, the value of I-2 was 0.0% (P = 0.792, OR = 2.70) when vancomycin powder was directly sprinkled into all layers of the wound. However, there is high heterogenicity (I-2 = 60.0%, P = 0.007, OR = 2.83) when vancomycin powder is not exposed to the bone graft and instrumentation. There are differences found with the method of local application of vancomycin for reducing postoperative wounds and further studies are necessary, including investigations focusing on the dose-dependent effects during spinal or the topical pharmacokinetic and other orthopaedic surgeries.
引用
收藏
页码:350 / 358
页数:9
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