1
|
Morgan E, Onuminya JE, Osime CO, Adebayo BO, Ehioghae O, Adetunmbi B. Efficacy of prophylactic use of intraoperative vancomycin powder in preventing surgical site infection in neurological surgeries in Irrua, Nigeria: A randomized controlled study. J Clin Neurosci 2024; 121:155-160. [PMID: 38401293 DOI: 10.1016/j.jocn.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 02/02/2024] [Accepted: 02/09/2024] [Indexed: 02/26/2024]
Abstract
PURPOSE The objective was to determine the efficacy of intraoperative vancomycin powder in preventing SSIs in neurological surgeries. METHODS A prospective randomized controlled study of patients who had clean cranial and non-implant spine surgeries at the Irrua Specialist Teaching Hospital, Irrua, Nigeria from February 1, 2021 to January 31, 2022. Patients were randomized into two groups. Group A patients had prophylactic intraoperative vancomycin powder applied to the surgical bed before wound closure while group B patients did not. Patients in both groups were followed up for 30 days post-operatively for evidence of SSI. The occurrence of SSIs was determined using clinical and laboratory parameters. Baseline characteristics, operative details, rates of wound infection, and microbiological data for each case were recorded. Data was analyzed using Statistical Package for Scientific Solution (SPSS) version 23 software. RESULTS Forty-two patients were randomized into 2 groups of 21 patients each. The age range of the patients was 20 to 80 years. The majority of the patients were males (32 out of 42). The mean age of patients in group A was 48.05 ± 17.03 years, while group B had a mean age of 45.95 ± 19.14 years. The mean Body Mass Index of patients in groups A and B were 23.92 ± 5.21 and 23.21 ± 3.99 respectively. Seven out of 21 patients (33.3 %) in the control group ( group B) had superficial SSIs while no patient in the experimental group had SSI, p-value < 0.05. The organisms cultured were Klebsiella pneumoniae, Pseudomonas aeruginosa, and Staphylococcus aureus. CONCLUSION Intraoperative vancomycin powder was effective in reducing the rate of SSIs following neurological surgeries and without adverse drug reactions.
Collapse
Affiliation(s)
- E Morgan
- Department of Surgery, Irrua Specialist Teaching Hospital Irrua, Nigeria; Department of Surgery, Babcock University, Ilishan-Remo, Ogun state, Nigeria.
| | - J E Onuminya
- Department of Orthopedic Surgery, Ambrose Alli University Ekpoma, Nigeria
| | - C O Osime
- Department of Surgery, University of Benin Teaching Hospital Benin, Nigeria
| | - B O Adebayo
- Neurosurgery Unit, Department of Surgery, Federal Medical Center, Abeokuta, Nigeria
| | - O Ehioghae
- Department of Surgery, Babcock University, Ilishan-Remo, Ogun state, Nigeria
| | - B Adetunmbi
- Neurosurgery Unit, Department of Surgery, Federal Medical Center, Abeokuta, Nigeria
| |
Collapse
|
2
|
Wang JL, Wu XW, Wang SN, Liu X, Xiao B, Wang Y, Yu J. Factors influencing the surveillance of re-emerging intracranial infections in elective neurosurgical patients: A single-center retrospective study. World J Clin Cases 2023; 11:6680-6687. [PMID: 37901028 PMCID: PMC10600856 DOI: 10.12998/wjcc.v11.i28.6680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/02/2023] [Accepted: 09/06/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND At present, many studies have reported the risk factors for postoperative intracranial reinfection, including age, sex, time to surgery, duration of postoperative catheterization, emergency procedures, type of disease and cerebrospinal fluid leakage, but the academic community has not reached a unified conclusion. AIM To find factors influencing the surveillance of re-emerging intracranial infections in elective neurosurgical patients. METHODS Ninety-four patients who underwent elective craniotomy from January 1, 2015 to December 31, 2022 in the Department of Neurosurgery, First Hospital of Jilin University, were included in this study. Of those, 45 patients were enrolled in the infection group, and 49 were enrolled in the control group. The clinical data of the patients were collected and divided into three categories, including preoperative baseline conditions, intraoperative characteristics and postoperative infection prevention. The data were analyzed using SPSS 26.0 software. RESULTS There were 23 males and 22 females in the infection group with a mean age of 52.8 ± 15.1 years and 17 males and 32 females in the control group with a mean age of 48.9 ± 15.2 years. The univariate analysis showed that the infection group had higher systolic blood pressures and postoperative temperatures, fewer patients who underwent a supratentorial craniotomy, more patients with a history of hypertension and higher initial postoperative white blood cell counts than the control group, with statistically significant differences (P < 0.05). The multifactorial logistic regression analysis showed that a history of hypertension and a high postoperative body temperature were independent risk factors for postoperative infection in neurosurgical patients. CONCLUSION The results obtained in this study indicated that a history of hypertension and a high postoperative body temperature were independent risk factors for postoperative neurological symptoms.
Collapse
Affiliation(s)
- Jiang-Long Wang
- The First Operating Room, The First Hospital of Jilin University, Changchun 130000, Jilin Province, China
| | - Xi-Wen Wu
- The First Operating Room, The First Hospital of Jilin University, Changchun 130000, Jilin Province, China
| | - Sheng-Nan Wang
- Department of Neurology, The First Hospital of Jilin University, Changchun 130000, Jilin Province, China
| | - Xuan Liu
- The First Operating Room, The First Hospital of Jilin University, Changchun 130000, Jilin Province, China
| | - Bing Xiao
- The First Operating Room, The First Hospital of Jilin University, Changchun 130000, Jilin Province, China
| | - Yu Wang
- The First Operating Room, The First Hospital of Jilin University, Changchun 130000, Jilin Province, China
| | - Jing Yu
- The First Operating Room, The First Hospital of Jilin University, Changchun 130000, Jilin Province, China
| |
Collapse
|
3
|
Sonbol AM, Baabdullah AM, Mohamed MAA, Kassab FN. Intrawound low-dose vancomycin is superior to high-dose in controlling the risk of wound dehiscence in spine surgeries. Medicine (Baltimore) 2023; 102:e33369. [PMID: 37058065 PMCID: PMC10101275 DOI: 10.1097/md.0000000000033369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 03/07/2023] [Indexed: 04/15/2023] Open
Abstract
Wound complications in spine surgeries are common and serious. This study aimed to determine the risk of wound dehiscence with a low-dose of intrawound vancomycin compared to that with a high-dose and no-vancomycin and its effectiveness in the prevention of surgical site infection. Patients were categorized into 3 groups. The first group did not receive any intrawound vancomycin. In the second, patients received a high-dose of vancomycin (1 g). The third group included patients who received a low-dose of intrawound vancomycin (250 mg). Patient demographics, clinical data, and surgical data were also collected. Multivariate linear regression analysis was used to examine factors associated with dehiscence or infection. Of the 391 patients included in our study, 56 (14.3%) received a high-dose of intrawound vancomycin, 126 (32.2%) received a low-dose, and 209 (53.5%) did not receive any treatment. The overall incidence of wound dehiscence was 6.14% (24 out of 391 patients). Wound dehiscence was significantly higher (P = .039) in the high-dose vancomycin group than in the low-dose vancomycin group. The overall incidence of postoperative infection was 2.05% (8 patients) and no statistically significant differences were observed between the low-dose and high-dose vancomycin groups. Patients with higher body mass index were more likely to experience wound dehiscence and postoperative infection, irrespective of the dose of vancomycin used. The use of low-dose intrawound vancomycin (250 mg) resulted in less wound dehiscence compared with high-dose vancomycin. Further trials are required to evaluate the effectiveness of the low-dose in preventing postoperative infections.
Collapse
Affiliation(s)
- Ahmed M. Sonbol
- Musculoskeletal Center of Excellence, International Medical Center, Jeddah, Saudi Arabia
| | - Ayman M. Baabdullah
- Musculoskeletal Center of Excellence, International Medical Center, Jeddah, Saudi Arabia
| | | | - Farid N. Kassab
- Musculoskeletal Center of Excellence, International Medical Center, Jeddah, Saudi Arabia
| |
Collapse
|
4
|
Tian B, He Y, Han Z, Liu T, Zhang X. Effect of powdered vancomycin on stopping surgical site wound infections in neurosurgery: A meta-analysis. Int Wound J 2023; 20:1139-1150. [PMID: 36237125 PMCID: PMC10031230 DOI: 10.1111/iwj.13973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/15/2022] [Accepted: 09/27/2022] [Indexed: 11/28/2022] Open
Abstract
We performed a meta-analysis to evaluate the effect of powdered vancomycin on stopping surgical site wound infections in neurosurgery. A systematic literature search up to July 2022 was performed and 24 137 subjects with neurosurgery at the baseline of the studies; 10 496 of them were using the powdered vancomycin, and 13 641 were not using the powdered vancomycin as a control. Odds ratio (OR) with 95% confidence intervals (CIs) were calculated to assess the effect of powdered vancomycin on stopping surgical site wound infections in neurosurgery using dichotomous methods with a random or fixed-effect model. The powdered vancomycin had significantly lower surgical site wound infections after spinal surgery (OR, 0.53; 95% CI, 0.41-0.70, P < .001), deep surgical site wound infections after spinal surgery (OR, 0.45; 95% CI, 0.35-0.57, P < .001), superficial surgical site wound infections after spinal surgery (OR, 0.60; 95% CI, 0.43-0.83, P = .002), and surgical site wound infections after cranial surgery (OR, 0.37; 95% CI, 0.22-0.61, P < .001) compared to control in subjects with neurosurgery. The powdered vancomycin had significantly lower surgical site wound infections after spinal surgery, deep surgical site wound infections after spinal surgery, superficial surgical site wound infections after spinal surgery, and surgical site wound infections after cranial surgery compared to control in subjects with neurosurgery. The analysis of outcomes should be done with caution even though the low number of studies with low sample size, 3 out of the 42 studies, in the meta-analysis, and a low number of studies in certain comparisons.
Collapse
Affiliation(s)
- Bo Tian
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Yanli He
- Department of Radiology, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Zian Han
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Tianjing Liu
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Xingye Zhang
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
| |
Collapse
|
5
|
Zeng X, Yang B, Zhang B, Xu B, Rong C, She J, Guo W, Kong J, Liu Y, Zhao D, Xu X. A meta‐analysis examined the effect of intrawound vancomycin on surgical site wound infections in non‐spinal neurosurgical operation. Int Wound J 2022; 20:1584-1590. [PMID: 36424840 PMCID: PMC10088818 DOI: 10.1111/iwj.14014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 10/24/2022] [Accepted: 10/24/2022] [Indexed: 11/26/2022] Open
Abstract
To assess the impact of intrawound vancomycin on surgical site wound infections in non-spinal neurosurgical operations, we conducted a meta-analysis. A thorough review of the literature up to September 2022 showed that 4286 participants had a non-spinal neurosurgical operation at the start of the investigations; 1975 of them used intrawound vancomycin, while 2311 were control. Using dichotomous or contentious methods and a random or fixed-effect model, odds ratios (OR) and mean difference (MD) with 95% confidence intervals (CIs) were estimated to evaluate the impact of intrawound vancomycin on surgical site wound infections in non-spinal neurosurgical operation. The intrawound vancomycin had significantly lower surgical site wound infections (OR, 0.28; 95% CI, 0.19-0.40; P < .001) with low heterogeneity (I2 = 32%) compared with the control in non-spinal neurosurgical operation. The intrawound vancomycin had significantly lower surgical site wound infections compared with control in non-spinal neurosurgical operation. The low sample size of 2 out of 13 researches in the meta-analysis calls for care when analysing the results.
Collapse
Affiliation(s)
- Xiangwu Zeng
- Department of Brain The Second People's Hospital of Zhangye City Zhangye Gansu China
| | - Bo Yang
- Department of Pharmacy The Second People's Hospital of Zhangye City Zhangye Gansu China
| | - Baiming Zhang
- Department of Pharmacy The Second People's Hospital of Zhangye City Zhangye Gansu China
| | - Buxuan Xu
- Department of Brain The Second People's Hospital of Zhangye City Zhangye Gansu China
| | - Congxue Rong
- Department of Brain The Second People's Hospital of Zhangye City Zhangye Gansu China
| | - Jianhu She
- Department of Brain The Second People's Hospital of Zhangye City Zhangye Gansu China
| | - Wanliang Guo
- Department of Brain The Second People's Hospital of Zhangye City Zhangye Gansu China
| | - Jianlong Kong
- Department of Brain The Second People's Hospital of Zhangye City Zhangye Gansu China
| | - Yangzi Liu
- Department of Brain The Second People's Hospital of Zhangye City Zhangye Gansu China
| | - Dianfan Zhao
- Department of Brain The Second People's Hospital of Zhangye City Zhangye Gansu China
| | - Xiuzhen Xu
- Department of Pharmacy The Second People's Hospital of Zhangye City Zhangye Gansu China
| |
Collapse
|
6
|
Springer BD. Irrigation Solutions and Antibiotic Powders: Should I Use Them in Primary and Revision Total Joint Arthroplasty? J Arthroplasty 2022; 37:1438-1440. [PMID: 35247486 DOI: 10.1016/j.arth.2022.02.096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/18/2022] [Accepted: 02/22/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The prevention and treatment of periprosthetic joint infection is of utmost importance to orthopedic surgeons. Irrigation solutions have become a popular additive to the prevention and treatment armamentarium. METHODS This symposium summarizes the mechanism of action, basic science, and clinical research to date on the use of irrigation solutions. The four most commonly used irrigation solutions, povidone iodine, chlorhexidine, hydrogen peroxide, and acetic acid, are discussed. In addition, the role of antibiotic powers is reviewed. RESULTS Each solution has its risks and benefits that must be weighed by the surgeon. There is no clear irrigation solution that is superior. The role of additive antibiotic powder (vancomycin) remains controversial. CONCLUSION More rigorous prospective clinical trials are needed to determine the optimal irrigation solution for the prevention and treatment of periprosthetic joint infection.
Collapse
Affiliation(s)
- Bryan D Springer
- OrthoCarolina Hip and Knee Center, Atrium Musculoskeletal Institute, Charlotte, NC
| |
Collapse
|
7
|
Schmitz MW, Wojahn RD. Supratherapeutic Antibiotic Levels and Acute Kidney Injury from Absorption of Topical Antibiotics: A Case Report. JBJS Case Connect 2022; 12:01709767-202206000-00040. [PMID: 36099510 DOI: 10.2106/jbjs.cc.22.00145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CASE A 96-year-old woman with no baseline renal dysfunction presented with a distal femoral shaft fracture after a ground-level fall. Treatment was with a retrograde intramedullary nail and included placement of topical antibiotics. Postoperatively, she developed acute kidney injury and was found to have supratherapeutic antibiotic levels. CONCLUSION This case report demonstrates the risk of clinically relevant systemic absorption along with associated downstream end organ damage with the use of topical antibiotics in certain circumstances. We present this case as an illustration of a rare hazard associated with topical antibiotic use.
Collapse
Affiliation(s)
- Michael W Schmitz
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Robert D Wojahn
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
- Department of Orthopaedic Surgery, Regions Hospital, Saint Paul, Minnesota
| |
Collapse
|
8
|
VANCO Trial – Preliminary Results on the Safety Profile of Intrawound Vancomycin Powder in Complex Spine Surgery. World Neurosurg 2022; 162:7-8. [DOI: 10.1016/j.wneu.2022.03.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
9
|
Salimi S, Khayat Kashani HR, Azhari S, Sadeghi S, Sheikhghomy S, Paryan P, KhayatKashani M. Local vancomycin therapy to reduce surgical site infection in adult spine surgery: a randomized prospective study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:454-460. [PMID: 34750670 DOI: 10.1007/s00586-021-07050-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 10/07/2021] [Accepted: 10/28/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE This prospective randomized controlled trial hypothesizes that intra wound vancomycin reduces postoperative infection. METHODS In this RCT study, the patients were randomly divided into two groups of treatment and control. In the treatment group, 1-2 g of intra wound vancomycin was used, and no drug was used for the control group. SSI and the type of microorganism causing postoperative infection were assessed at a three-month follow-up. Factors affecting postoperative infection such as age, sex, site of operation, surgical levels, and risk factors affecting postoperative infection, such as diabetes, blood pressure, ischemic heart disease, smoking, blood transfusion, BMI, neurologic deficit, CSF leakage, UTI, COPD and surgery time were examined in two groups. RESULTS In this study, 375 patients, including 187patients in the treatment group and 188 patients in the control group, were studied. Among the patients, 228 had surgery without instrumentation, and 147 had surgery with instrumentation. There were 12 cases of SSI in the treatment group and 11 in the control group, and there was no statistically significant difference between the two groups. There was no difference between the two groups with and without instrumentation in the evaluation of postoperative infection. In the subgroups with and without instruments, there was no significant difference between treatment and control groups. Due to the microorganism causing the infection, gram-negative bacteria were more common in the treatment group. CONCLUSION Intra-wound vancomycin has no effect on SSI; in addition, it can increase the rate of gram-negative infections.
Collapse
Affiliation(s)
- Sohrab Salimi
- Clinical Research and Development Unit, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Khayat Kashani
- Department of Neurosurgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Madani street, Tehran, Iran.
| | - Shirzad Azhari
- Department of Neurosurgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Madani street, Tehran, Iran
| | - Sohrab Sadeghi
- Department of Neurosurgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Madani street, Tehran, Iran
| | - Siavash Sheikhghomy
- Department of Neurosurgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Madani street, Tehran, Iran
| | - Poorya Paryan
- Department of Neurosurgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Madani street, Tehran, Iran
| | - Maryam KhayatKashani
- Clinical Research and Development Unit, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
10
|
Schär RT, Jesse CM, Montalbetti M, Söll N, Lutz K, Steinsiepe V, Branca M, Raabe A, Zimmerli S. Negligible Systemic Uptake of Suprafascial Vancomycin Powder Following Instrumented Posterior Spinal Fusion-Preliminary Results From A Randomized Clinical Trial (VANCO Trial). Neurosurgery 2021; 89:967-972. [PMID: 34528089 DOI: 10.1093/neuros/nyab362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/03/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Intrawound vancomycin powder is an emerging strategy to reduce surgical site infections (SSIs) in spine surgery. However, there are concerns relating to its safety profile and toxicity. Data on systemic uptake of suprafascially administered vancomycin powder following instrumented spinal fusion is lacking. OBJECTIVE To study the systemic uptake and safety of suprafascially administered vancomycin powder in the early postoperative phase following open instrumented posterior spinal fusion. METHODS This was a substudy of an ongoing randomized clinical trial. Eligible adult patients were randomized 1:1 to either receive suprafascial vancomycin powder before wound closure or not to receive vancomycin powder. Serum vancomycin levels were assessed on postoperative days 1 and 2, serum creatinine levels were measured pre- and post-operatively. Adverse events up to 6 wk following surgery were recorded. RESULTS Among 34 randomized patients (mean age 62 yr, range 31-84 yr; 18 [53%] women), 17 received vancomycin powder. No detectable serum vancomycin levels (>4.0 mg/L) were found. Proportion of adverse events per patient in the vancomycin and control group, respectively, were 29.4% (5/17) vs 11.8% (2/17) (OR 3.12; 95% CI, 0.52; 19.38; P = .398). No patient had nephrotoxicity or ototoxicity in either group. CONCLUSION Suprafascial vancomycin powder in open instrumented spinal fusion surgery is safe and results in negligible systemic uptake. Final results of the VANCO Trial need to be awaited for conclusive data on the efficacy of vancomycin for SSI prevention and its impact on wound healing.
Collapse
Affiliation(s)
- Ralph T Schär
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - C Marvin Jesse
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matteo Montalbetti
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicole Söll
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Katharina Lutz
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Valentin Steinsiepe
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Andreas Raabe
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stefan Zimmerli
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
11
|
Jiménez-Martínez E, Cuervo G, Carratalà J, Hornero A, Ciercoles P, Gabarrós A, Cabellos C, Pelegrin I, Domínguez-Luzón MA, Càmara J, Moreno-Fuentes R, Adamuz J, Pujol M. Economic impact of a care bundle to prevent surgical site infection after craniotomy: a cost-analysis study. Antimicrob Resist Infect Control 2021; 10:146. [PMID: 34645525 PMCID: PMC8513215 DOI: 10.1186/s13756-021-01016-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/27/2021] [Indexed: 11/15/2022] Open
Abstract
Background Surgical site infections after craniotomy (SSI-CRAN) significantly impact patient outcomes and healthcare costs by increasing length of stay and readmission and reoperation rates. However, to our knowledge, no study has yet analysed the economic impact of a surgical care bundle for preventing SSI-CRAN. The aim is to analyse the hospital cost saving after implementation of a care bundle for the prevention of SSI-CRAN. Methods A retrospective cost-analysis was performed, considering two periods: pre-care bundle (2013–2015) and care bundle (2016–2017). A bottom-up approach was used to calculate the costs associated with infection in patients who developed a SSI-CRAN in comparison to those who did not, in both periods and on a patient-by-patient basis. The derived cost of SSI-CRAN was calculated considering: (1) cost of the antibiotic treatment, (2) cost of length of stay in the neurosurgery ward within the 1-year follow up period, (3) cost of the re-intervention, and (4) cost of the implant for cranial reconstruction, when necessary. Results A total of 595 patients were included in the pre-care bundle period and 422 in the care bundle period. Mean cost of a craniotomy procedure was approximately €8000, rising to €24,000 in the case of SSI-CRAN. Mean yearly hospital costs fell by €502,857 in the care bundle period (€714,886 vs. €212,029). Extra costs between periods were mainly due to increased length of hospital stay (€573,555.3 vs. €183,958.9; difference: €389,596.4), followed by the cost of implant for cranial reconstruction (€69,803.4 vs. €9,936; difference: €59,867.4). Overall, implementation of the care bundle saved the hospital €500,844.3/year. Conclusion The implementation of a care bundle for SSI-CRAN had a significant economic impact. Hospitals should consider the deployment of this multimodal preventive strategy to reduce their SSI-CRAN rates, and also their costs. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-021-01016-4.
Collapse
Affiliation(s)
- Emilio Jiménez-Martínez
- Infectious Diseases Department, Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Guillermo Cuervo
- Infectious Diseases Department, Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain. .,Spanish Network for Research in Infectious Diseases (REIPI), Instituto Carlos III, Madrid, Spain.
| | - Jordi Carratalà
- Infectious Diseases Department, Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI), Instituto Carlos III, Madrid, Spain
| | - Ana Hornero
- Infectious Diseases Department, Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Pilar Ciercoles
- Infectious Diseases Department, Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Andreu Gabarrós
- Neurosurgery Department, Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - Carmen Cabellos
- Infectious Diseases Department, Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI), Instituto Carlos III, Madrid, Spain
| | - Ivan Pelegrin
- Infectious Diseases Department, Parc de Salut Mar, Barcelona, Spain
| | - Maria Angeles Domínguez-Luzón
- Microbiology Department, Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain.,Research Network for Respiratory Diseases (CIBERES), ISCIII, Madrid, Spain
| | - Jordi Càmara
- Microbiology Department, Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain.,Research Network for Respiratory Diseases (CIBERES), ISCIII, Madrid, Spain
| | - Ramon Moreno-Fuentes
- Finance Department, Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - Jordi Adamuz
- Nursing Information Systems Department Support, Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain.,University of Barcelona, Barcelona, Spain
| | - Miquel Pujol
- Infectious Diseases Department, Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI), Instituto Carlos III, Madrid, Spain
| |
Collapse
|
12
|
Surgical Site Infection After Autologous Cranioplasty for Decompressive Craniectomy in Traumatic Brain Injury: A Retrospective Review of Two Level 1 Trauma Centers. J Craniofac Surg 2021; 32:2728-2731. [PMID: 34260461 DOI: 10.1097/scs.0000000000007830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECT Surgical site infection (SSI) after cranioplasty can result in unnecessary morbidity. This analysis was designed to determine the risk factors of SSI after cranioplasty in patients who received a decompressive craniectomy with the autologous bone for traumatic brain injury (TBI). METHODS A retrospective review was performed at two level 1 academic trauma centers for adult patients who underwent autologous cranioplasty after prior decompressive craniectomy for TBI. Demographic and procedural variables were collected and analyzed for associations with an increased incidence of surgical site infection with two-sample independent t tests and Mann Whitney U tests, and with a Bonferroni correction applied in cases of multiple comparisons. Statistical significance was reported with a P value of < 0.05. RESULTS A total of 71 patients were identified. The mean interval from craniectomy to cranioplasty was 99 days (7-283), and 3 patients developed SSIs after cranioplasty (4.2%). Postoperative drain placement (P > 0.08) and administration of intrawound vancomycin powder (P = 0.99) were not predictive of infection risk. However, a trend was observed suggesting that administration of prophylactic preoperative IV vancomycin is associated with a reduced infection rate. CONCLUSIONS The SSI rate after autologous cranioplasty in TBI patients is lower than previously reported for heterogeneous groups and indications, and the infection risk is comparable to other elective neurosurgical procedures. As such, the authors recommend attempting to preserve native skull and perform autologous cranioplasty in this population whenever possible.
Collapse
|
13
|
Shan S, Tu L, Gu W, Aikenmu K, Zhao J. A meta-analysis of the local application of vancomycin powder to prevent surgical site infection after spinal surgeries. J Int Med Res 2021; 48:300060520920057. [PMID: 32723127 PMCID: PMC7391445 DOI: 10.1177/0300060520920057] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Objective This study aimed to systematically analyze the effectiveness and safety of the local application of vancomycin powder to prevent surgical site infection (SSI) after spinal surgeries and provide guidance for clinical practice. Methods Two researchers independently searched PubMed, Web of Science, Elsevier, and China National Knowledge Infrastructure using the MeSH terms “spinal surgery,” “vancomycin,” “local,” “topical,” “prophylactic,” “surgical site infection,” and “SSI” to identify studies published between January 2010 and January 2020 on the local application of vancomycin powder for preventing SSI after spinal surgeries. The outcome assessment indicators were analyzed using RevMan 5.3 software. Results Three randomized controlled trials, two prospective studies, and 26 retrospective studies were included in the current research. The results of the meta-analysis revealed significant differences between the vancomycin and control groups (non-vancomycin group) concerning the incidence of SSI (risk ratio = 0.39, 95% confidence interval = 0.28–0.55, Z = 5.46), indicating that local application of vancomycin powder can significantly reduce the incidence of SSI. Conclusion Local application of vancomycin powder is an effective and safe method to prevent SSI after spinal surgeries.
Collapse
Affiliation(s)
- Shuo Shan
- Department of Spine Surgery of Traditional Chinese Hospital Affiliated With Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Laiyong Tu
- Department of Spine Surgery of Traditional Chinese Hospital Affiliated With Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Wenfei Gu
- Department of Spine Surgery of Traditional Chinese Hospital Affiliated With Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Kahaer Aikenmu
- Department of Spine Surgery of Traditional Chinese Hospital Affiliated With Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Jiang Zhao
- Department of Spine Surgery of Traditional Chinese Hospital Affiliated With Xinjiang Medical University, Urumqi, Xinjiang, China
| |
Collapse
|
14
|
Vakayil V, Atkinson J, Puram V, Glover JJ, Harmon JV, Statz CL, Polly DW, Bulander RE. Intrawound vancomycin application after spinal surgery: a propensity score-matched cohort analysis. J Neurosurg Spine 2021:1-11. [PMID: 33668035 DOI: 10.3171/2020.8.spine201129] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 08/31/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Surgical site infection (SSI) following spine surgery is associated with increased morbidity and healthcare costs. In an effort to reduce SSI rates, the application of intrawound vancomycin powder has gained popularity. However, there is limited high-quality evidence to support the safety and efficacy of this practice. The authors sought to determine if intrawound application of vancomycin powder improves 90-day overall SSI rates. METHODS The authors performed a retrospective, vancomycin exposure-matched cohort study at a single tertiary care hospital over 21 months. They included all patients undergoing elective spinal surgery and stratified the patients into two groups: those who received intrawound vancomycin powder application and those who received no application of vancomycin powder. The primary outcome of interest was the 90-day overall SSI rate. Secondary outcomes included rates of superficial SSI, deep SSI, wound disruption, and a post hoc analysis of the microbiology and minimum inhibitory concentrations. Baseline patient demographics, clinical presentation, comorbidities, perioperative factors, and 90-day postoperative outcomes were manually abstracted from patient charts. To mitigate bias, we performed 1:1 matching after calculating propensity scores and identified 1 patient from the no-vancomycin cohort for each patient in the vancomycin cohort. RESULTS A total of 997 patients met our inclusion criteria (473 patients receiving vancomycin and 524 patients not receiving vancomycin). Propensity score matching produced 221 matched pairs. Risk-adjusted analysis demonstrated similar overall SSI rates between the groups (OR 1.9, p = 0.329). On unadjusted analysis, the overall 90-day SSI rate was greater in the vancomycin group (n = 10 [4.5%]) than in the no-vancomycin group (n = 5 [2.3%]) (p < 0.001), as were the superficial SSI rate (7 [3.2%] vs 4 [1.8%], p < 0.001), deep SSI rate (3 [1.4%] vs 1 [0.5%], p < 0.001), and wound disruption rate (5 [2.3%] vs 1 [0.5%], p < 0.001). No cultured isolate demonstrated vancomycin resistance. CONCLUSIONS The authors observed no difference in SSI rates after the intrawound application of vancomycin powder during spine surgery. Vancomycin use did not contribute to antimicrobial resistance; however, it may select out gram-negative bacteria and increase rates of wound disruption.
Collapse
Affiliation(s)
| | | | | | | | | | | | - David W Polly
- 4Department of Orthopedics, University of Minnesota, Minneapolis, Minnesota
| | | |
Collapse
|
15
|
Kerezoudis P, Kelley PC, Watts CR, Heiderscheit CJ, Roskos MC. Using a Data-Driven Improvement Methodology to Decrease Surgical Site Infections in a Community Neurosurgery Practice: Optimizing Preoperative Screening and Perioperative Antibiotics. World Neurosurg 2021; 149:e989-e1000. [PMID: 33515799 DOI: 10.1016/j.wneu.2021.01.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/13/2021] [Accepted: 01/15/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We used a data-driven methodology to decrease the departmental surgical site infection rate to a goal of 1%. METHODS A prospective interventional study with historical controls comparing preimplementation/intervention (unknown methicillin-sensitive Staphylococcus aureus [MSSA]/methicillin-resistant Staphylococcus aureus [MRSA] status and standard weight and drug allergy-based preoperative antibiotics) with postimplementation/intervention (optimized preoperative chlorhexidine showers, MSSA/MRSA screening, MSSA/MRSA decolonization, and optimized preoperative antibiotic order set implementation). The American College of Surgeons National Surgical Quality Improvement Program was used for case surveillance. The primary outcome was the presence of a surgical site infection with a secondary outcome of cost(s) of implementation. RESULTS A total of 317 National Surgical Quality Improvement Program abstracted neurosurgical cases were analyzed, 163 cases before implementation and 154 cases after implementation. There were no significant differences between the preimplementation and postimplementation cohorts regarding patient demographics and baseline comorbidities, with the exceptions of inpatient and functional status (P < 0.001). The most common procedures were lumbar decompression (31%), lumbar discectomy (27%), and anterior cervical discectomy and fusion (10.4%). After implementation, 30 patients were MSSA positive (20%) and 4 MRSA positive (2.6%). Thirty patients received preoperative intranasal mupirocin decolonization (88%), and 4 patients received adjusted preoperative antibiotics (12%). After protocol implementation, the surgical site infection rate decreased from 6.7% (odds ratio, 2.82) to 0.96% (odds ratio, 0.91). The cost of implementation was $27,179, or $58 per patient. CONCLUSIONS The findings highlight the importance of systematically investigating areas of gap in existing clinical practice and quality improvement projects to increase patient safety and enhance the value of care delivered to neurosurgical patients.
Collapse
Affiliation(s)
| | - Parker C Kelley
- Department of Neurosurgery, Mayo Clinic Health System, La Crosse, Wisconsin, USA
| | - Charles R Watts
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurosurgery, Mayo Clinic Health System, La Crosse, Wisconsin, USA.
| | - Chris J Heiderscheit
- Department of Clinical Quality Management, Mayo Clinic Health System, La Crosse, Wisconsin, USA
| | - Michael C Roskos
- Department of Surgery, Mayo Clinic Health System, La Crosse, Wisconsin, USA
| |
Collapse
|
16
|
Mann M, Wright CH, Jella T, Labak CM, Shammassian B, Srivatsa S, Wright J, Engineer L, Sajatovic M, Selman W. Cranial Surgical Site Infection Interventions and Prevention Bundles: A Systematic Review of the Literature. World Neurosurg 2021; 148:206-219.e4. [PMID: 33412319 DOI: 10.1016/j.wneu.2020.12.137] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 12/27/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Cranial surgical site infections (cSSIs) are associated with significant morbidity. Measures to reduce cSSI are necessary to reduce patient morbidity as well as hospital costs and resource utilization. OBJECTIVE To identify and characterize interventions or bundled interventions aimed at reduction of the incidence of cranial surgical site infections. METHODS A systematic review of the literature was conducted according to the PRISMA guidelines. The search strategy included randomized trials, quasi-experimental studies, cohort studies, and case series published between 2000 and 2020 that evaluated interventions implemented to reduce cSSI. Bias assessments and data extraction were performed on included studies. RESULTS The initial search generated 1249 studies. Application of inclusion and exclusion criteria and review of references yielded 15 single-intervention and 6 bundled-intervention studies. The single interventions included handwashing protocols, use of vancomycin powder, hair washing and clipping practices, and incision closure techniques. Bundled interventions addressed a variety of preoperative, intraoperative, and postoperative changes. Despite a lack of strong evidence to support the adoption of statistically significant interventions, the use of vancomycin powder may be effective in reducing cSSI. In addition, bundled interventions that involved cultural changes, such as increased teaching/education, personal accountability, direct observation, and feedback, showed some success in decreasing SSI rates. CONCLUSIONS The strength of the conclusions is limited by small sample sizes, study heterogeneity, relatively low cSSI incidence, and high case variability. Some evidence supports the use of intraoperative vancomycin powder in adult noncranioplasty cases and the application of accountability, teaching, and surveillance of faculty, particularly those early in training.
Collapse
Affiliation(s)
- Michael Mann
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Christina Huang Wright
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
| | - Tarun Jella
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Collin M Labak
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Berje Shammassian
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Shaarada Srivatsa
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - James Wright
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Lilly Engineer
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medicine and Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Martha Sajatovic
- Department of Neurology, and Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Neurological and Behavioral Outcomes Research Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Warren Selman
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| |
Collapse
|
17
|
Adapa AR, Linzey JR, Daou BJ, Mehta UV, Patel T, Ponnaluri-Wears S, Washer LL, Thompson BG, Park P, Pandey AS. Evaluating the role of methicillin-resistant Staphylococcus aureus (MRSA)-specific antibiotic prophylaxis for neurosurgical patients. Clin Neurol Neurosurg 2020; 200:106353. [PMID: 33168331 DOI: 10.1016/j.clineuro.2020.106353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Surgical site infection (SSI) in neurosurgical patients increases morbidity. Despite the rise of methicillin-resistant Staphylococcus aureus (MRSA) colonization, there is little consensus regarding antibiotic prophylaxis for SSI in MRSA-colonized neurosurgical patients. Our objective was to examine the incidence of SSI in MRSA-colonized neurosurgical patients and interrogate whether MRSA-specific antibiotic prophylaxis reduces SSIs. METHODS We performed a retrospective analysis of adult patients undergoing neurosurgical procedures between 2013 and 2018. The primary outcome was SSI in patients with MRSA colonization receiving MRSA-specific antibiotics. Secondary outcomes included predictors of SSI, including whether broad use of MRSA-specific antibiotics affects SSI rate. RESULTS Of 9739 procedures, 376 had SSI (3.9 %). Seven hundred forty-four procedures (7.6 %) were performed on patients screened preoperatively for MRSA, including 54 procedures on MRSA-colonized patients. MRSA-colonized patients were more likely than MRSA-non-colonized patients to receive MRSA-specific antibiotics (35.2 % vs. 17.8 %, p = 0.002) for prophylaxis. Nevertheless, MRSA-colonized patients had higher SSI rates compared to MRSA-non-colonized patients (22.2 % vs. 6.4 %, p = 0.00002). MRSA-colonization led to 3.49 greater odds (95 % CI 1.52-7.65, p = 0.002) of SSI relative to MRSA-non-colonization. MRSA-colonized patients receiving MRSA-specific antibiotics, compared to those receiving non-MRSA-specific antibiotics, had lower SSI rates, but this difference was not statistically significant (15.8 % vs. 25.7 %, p = 0.40). In the non-screened population, those receiving MRSA-specific antibiotics, compared to those receiving non-MRSA-specific antibiotics, had significantly higher SSI rates (6.9 % vs. 3.0 %, p = 0.00001). The use of MRSA-specific antibiotic prophylaxis in the non-screened population increased the odds of SSI (OR 1.90, 95 % CI 1.45-2.46, p = 0.0001). CONCLUSION MRSA-colonized neurosurgical patients had a higher SSI rate compared to MRSA-non-colonized patients. While MRSA-specific antibiotics may benefit those with MRSA colonization, the difference in SSI rate between MRSA-colonized patients receiving MRSA-specific antibiotics vs. non-specific antibiotics requires further investigation. The broader use of MRSA-specific antibiotics may paradoxically confer an increased risk of SSI in a non-screened neurosurgical population.
Collapse
Affiliation(s)
- Arjun Rohit Adapa
- University of Michigan Medical School, Ann Arbor, MI, USA; Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | | | - Badih Junior Daou
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Unnati Vikram Mehta
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, MA, USA
| | - Twisha Patel
- Department of Pharmacy Services, University of Michigan, Ann Arbor, MI, USA
| | | | - Laraine Lynn Washer
- Division of Infectious Disease, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Paul Park
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA; Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | | |
Collapse
|
18
|
Karau MJ, Zhang C, Mandrekar JN, Kohrs NJ, Puleo DA, van Wijnen AJ, Patel R, Boyce TG, Larson AN, Milbrandt TA. Topical vancomycin for treatment of methicillin-resistant Staphylococcus epidermidis infection in a rat spinal implant model. Spine Deform 2020; 8:553-559. [PMID: 32078142 DOI: 10.1007/s43390-020-00087-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 01/05/2020] [Indexed: 11/30/2022]
Abstract
STUDY DESIGN Basic science. OBJECTIVE Investigate the ability of local applicaiton of vancomycin, either in powder form or suspended within poly(lactic-co-glycolic acid) microspheres (MS), to treat infection using a rat spinal model. Surgical site infections (SSIs) are a serious complication after spine surgery and are associated with high morbidity and mortality and often caused my coagulase negative staphylococci. A comprehensive approach to reduce SSIs has been recommended including the use of topical vancomycin. Animal and human studies have shown improved control of infection with local compared to systemic antibiotics. METHODS K-wires seeded with methicillin-resistant Staphylococcus epidermidis RP62A (MRSE) were treated with vancomycin powder, carboxymethylcellulose sodium salt (CMC) (microsphere carrier), vancomycin powder, blank MS or vancomycin-loaded MS for 24 or 48 h in vitro after which bacteria were enumerated. In addition, a spinal instrumentation model was developed in rats with a bacterial seeded K-wire implanted into the right side of L4 and L5. Rats underwent no treatment or were treated locally with either vancomycin powder, blank MS or vancomycin-loaded MS. After 8 weeks, the K-wire, bone, soft tissue and wire fastener were cultured and results analyzed. RESULTS Vancomycin powder and vancomycin-loaded MS resulted in significantly fewer bacteria remaining in vitro than did CMC. Vancomycin powder- treated animals' cultures were significantly lower than all other groups (P < 0.0001) with negative culture results, except for one animal. The vancomycin-loaded MS-treated animals had lower bone bacterial counts than the controls (P < 0.0279); blank MS-treated animals had no differences in bacterial densities when compared to non-treated animals. CONCLUSION Vancomycin powder and vancomycin-loaded MS were active against MRSE in vitro, in a rat MRSE implant model; however, vancomycin MS were inferior to the topical vancomycin powder. Vancomycin powder prevented MRSE infection in a rat spinal implant infection model.
Collapse
Affiliation(s)
- Melissa J Karau
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Chenghao Zhang
- Division of Pediatric Orthopedic Surgery, Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Jayawant N Mandrekar
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 55905, USA
| | - Nicholas J Kohrs
- F. Joseph Halcomb III Department of Biomedical Engineering, University of Kentucky, Lexington, KY, USA
| | - David A Puleo
- Department of Biomedical Engineering, University of Mississippi, Oxford, MS, USA
| | - Andre J van Wijnen
- Division of Pediatric Orthopedic Surgery, Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Robin Patel
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA.,Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Thomas G Boyce
- Department of Pediatrics, Division of Infectious Diseases and Immunology, Levine Children's Hospital, Charlotte, NC, USA
| | - A Noelle Larson
- Division of Pediatric Orthopedic Surgery, Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Todd A Milbrandt
- Division of Pediatric Orthopedic Surgery, Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, 55905, USA. .,Division of Orthopaedics, Mayo Clinic, 200 First St S.W., Rochester, MN, 55905, USA.
| |
Collapse
|
19
|
Jiménez-Martínez E, Cuervo G, Carratalà J, Hornero A, Ciercoles P, Gabarrós A, Cabellos C, Pelegrin I, Dominguez Luzón MA, García-Somoza D, Càmara J, Tebé C, Adamuz J, Pujol M. A Care Bundle Intervention to Prevent Surgical Site Infections after a Craniotomy. Clin Infect Dis 2020; 73:e3921-e3928. [PMID: 32594119 DOI: 10.1093/cid/ciaa884] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/22/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Although surgical site infections after a craniotomy (SSI-CRAN) are a serious problem involving significant morbidity and costs, information on their prevention is scarce. We aimed to assess whether the implementation of a care bundle was effective in preventing SSI-CRANs. METHODS A historical control study was used to evaluate the care bundle, which included a preoperative shower with 4% chlorhexidine soap, appropriate hair removal, adequate preoperative systemic antibiotic prophylaxis, the administration of 1 g of vancomycin powder into the subgaleal space before closing, and a post-operative dressing of the incisional surgical wound with a sterile absorbent cover. Patients were divided into 2 groups: pre-intervention (January 2013 to December 2015) and intervention (from January 2016 to December 2017). The primary study endpoint was the incidence of SSI-CRANs within a year post-surgery. Propensity score matching was performed and differences between the two study periods were assessed using Cox regression models. RESULTS A total of 595 and 422 patients were included in the pre-intervention and intervention periods, respectively. The incidence of SSI-CRANs was lower in the intervention period (15.3% vs. 3.5%; p < 0.001). Using a propensity score model, 421 pairs of patients were matched. The care bundle intervention was independently associated with a reduced incidence of SSI-CRANs (AOR: 0.23, 95% CI: 0.13-0.40; p < 0.001). CONCLUSION The care bundle intervention was effective in reducing SSI-CRAN rates. The implementation of this multimodal preventive strategy should be considered in centers with high SSI-CRAN incidences.
Collapse
Affiliation(s)
- Emilio Jiménez-Martínez
- Infectious Diseases Department, Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - Guillermo Cuervo
- Infectious Diseases Department, Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI), Instituto Carlos III, Madrid, Spain
| | - Jordi Carratalà
- Infectious Diseases Department, Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI), Instituto Carlos III, Madrid, Spain
| | - Ana Hornero
- Infectious Diseases Department, Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - Pilar Ciercoles
- Infectious Diseases Department, Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - Andres Gabarrós
- Neurosurgery Department, Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - Carmen Cabellos
- Infectious Diseases Department, Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI), Instituto Carlos III, Madrid, Spain
| | - Ivan Pelegrin
- Infectious Diseases Department, Hospital Parc Taulí, Fundació Institut d'Investigació i Innovació Parc Taulí (I3PT), Sabadell, Spain
| | - Maria Angeles Dominguez Luzón
- Microbiology Department, Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI), Instituto Carlos III, Madrid, Spain
| | - Dolores García-Somoza
- Microbiology Department, Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - Jordi Càmara
- Microbiology Department, Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain.,Nursing Information Systems Department Support, Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Biostatistics Unit, IDIBELL, L'Hospitalet de Llobregat, Spain.,Spanish Network for Research in Infectious Diseases (REIPI), Instituto Carlos III, Madrid, Spain.,Research Network for Respiratory Diseases (CIBERES), ISCIII, Madrid, Spain
| | - Cristian Tebé
- Biostatistics Unit, IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Jordi Adamuz
- Nursing Information Systems Department Support, Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain.,University of Barcelona, Barcelona, Spain
| | - Miquel Pujol
- Infectious Diseases Department, Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI), Instituto Carlos III, Madrid, Spain
| |
Collapse
|
20
|
Stepanov IA, Beloborodov VA, Borisov VE, Aliev MA, Shepelev VV, Pestryakov YY. [The effectiveness of local application of vancomycin powder in the prevention of surgical site infections in spine surgery: a meta-analysis]. Khirurgiia (Mosk) 2020:60-70. [PMID: 32573534 DOI: 10.17116/hirurgia202006160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To perform a meta-analysis of studies examining the effectiveness of the local application of vancomycin powder for the prophylaxis of surgical site infections (SSIs) in spine surgery. MATERIAL AND METHODS Retrospective cohort studies and prospective randomized clinical trials were searched for in the Pubmed, EMBASE, Cochrane Library and eLibrary databases published from 2008 to December 2018. For the resulting variables, the odds ratio and 95% confidence interval were calculated using random and fixed effects models. Estimation of the degree of heterogeneity is estimated using the coefficient I2. Statistically significant differences were considered differences p<0.05. RESULTS The meta-analysis included 28 clinical studies that included the results of the local application of vancomycin powder in 17,469 patients after performing various spinal surgical interventions. Two publications had a prospective, randomized, controlled study design. Topical application of vancomycin powder reduces the incidence of SSIs after spine surgery (p<0.0001). The use of vancomycin powder reduces the incidence of SSIs in patients operated on with stabilizing implants (p=0.004). On the other hand, the topical application of vancomycin powder did not affect the prevalence of SSIs in respondents who were operated on without the use of stabilizing implants (p=0.12) or due to deformities of the spine (p=0.06). CONCLUSION Topical application of vancomycin powder is highly effective in preventing the development of SSIs in patients after spinal surgical interventions.
Collapse
Affiliation(s)
- I A Stepanov
- Irkutsk State Medical University of the Ministry of Health of Russia, Irkutsk, Russia.,Kharlampiev Clinic, Irkutsk, Russia
| | - V A Beloborodov
- Irkutsk State Medical University of the Ministry of Health of Russia, Irkutsk, Russia
| | - V E Borisov
- Irkutsk State Medical University of the Ministry of Health of Russia, Irkutsk, Russia
| | - M A Aliev
- Irkutsk State Medical University of the Ministry of Health of Russia, Irkutsk, Russia
| | - V V Shepelev
- Irkutsk State Medical University of the Ministry of Health of Russia, Irkutsk, Russia
| | - Yu Ya Pestryakov
- Irkutsk State Medical University of the Ministry of Health of Russia, Irkutsk, Russia
| |
Collapse
|
21
|
Does Intra-Wound Vancomycin Powder Affect the Action of Intra-Articular Tranexamic Acid in Total Joint Replacement? Microorganisms 2020; 8:microorganisms8050671. [PMID: 32384628 PMCID: PMC7285138 DOI: 10.3390/microorganisms8050671] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/29/2020] [Accepted: 05/05/2020] [Indexed: 12/20/2022] Open
Abstract
The intra-articular use of tranexamic acid (TXA) has contributed to reduced blood loss in total joint arthroplasty (TJA). The purpose of this study is to assess the efficacy of simultaneously topical use of tranexamic acid and vancomycin powder within the TJA space. From 2016 to 2017, 219 consecutive total hip arthroplasties (THAs) and 272 total knee arthroplasties (TKAs) were performed in a tertiary care center, with a group of patients receiving intra-articular TXA and vancomycin, compared to patients receiving only TXA and to a control group that did not receive anything. Haemoglobin and hematocrit were measured preoperatively, on the first and third days. Transfusions and adverse events were recorded. Haemoglobin and hematocrit dropped significantly in all THA and TKA groups till the third day postoperatively, with a major reduction in the control group, compared to the other two treatment groups. Infections and thromboembolic events were similar in either group of the TJAs. In conclusion, the topical use of tranexamic acid mixed with the vancomycin powder within the joint space after the TJAs of the hip and knee did not alter the anti-fibrinolytic effect of TXA.
Collapse
|
22
|
Delgado-López PD, Martín-Alonso J, Martín-Velasco V, Castilla-Díez JM, Galacho-Harriero A, Ortega-Cubero S, Herrero-Gutiérrez AI, Rodríguez-Salazar A. Vancomycin powder for the prevention of surgical site infection in posterior elective spinal surgery. Neurocirugia (Astur) 2019; 31:64-75. [PMID: 31611139 DOI: 10.1016/j.neucir.2019.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/05/2019] [Accepted: 07/25/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To assess the effectiveness and safety of vancomycin powder as surgical site infection (SSI) prophylaxis in posterior bilateral elective spinal surgery. MATERIALS AND METHODS Single-center quasi-experimental pre and postintervention comparative cohort study. The post-intervention group received standard intravenous antibiotic prophylaxis plus 1g of vancomycin powder into the surgical field before wound closure, and the pre-intervention group only the intravenous prophylaxis. RESULTS 150 patients were included in each group. Twelve SSI (7 superficial and 5 deep) occurred in the post-intervention group and 16 SSI (7 superficial and 9 deep) in the pre-intervention group. The risk of deep SSI decreased from 6.0% to 3.3% (OR 0,54, 95%CI 0.17-1.65, p=0.411) with vancomycin powder. The percentage of deep SSI due to gram negative-positive germs were 80%-20% and 33%-67% for the post- and pre-intervention groups, respectively (p=0.265). No local or systemic adverse effects occurred attributable to vancomycin powder. CONCLUSION In posterior elective spinal surgery, prophylaxis with vancomycin powder did not result in a significantly reduced incidence of superficial and deep SSI. There was a trend towards a higher incidence of deep SSI caused by gram negative microorganisms among those treated with vancomycin.
Collapse
Affiliation(s)
| | | | | | | | | | - Sara Ortega-Cubero
- Servicio de Neurocirugía, Hospital Universitario de Burgos, Burgos, España
| | | | | |
Collapse
|
23
|
Ishida W, Perdomo-Pantoja A, Elder BD, Locke J, Holmes C, Witham TF, Lo SFL. Effects of Intraoperative Intrawound Antibiotic Administration on Spinal Fusion: A Comparison of Vancomycin and Tobramycin in a Rat Model. J Bone Joint Surg Am 2019; 101:1741-1749. [PMID: 31577679 DOI: 10.2106/jbjs.18.00988] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Local, intrawound use of antibiotic powder, such as vancomycin and tobramycin, in spinal fusion surgery has become an increasingly common prophylactic measure in an attempt to reduce rates of postsurgical infection. However, the effects of localized antibiotic delivery on fusion remain unclear. The objective of this study was to examine the in vivo effects of intraoperative local delivery of 2 antibiotics commonly used in bone-grafting surgery on spinal fusion outcomes in a rat model. METHODS Single-level (L4-L5), bilateral posterolateral intertransverse process lumbar fusion surgery was performed on 60 female Lewis rats (6 to 8 weeks of age) using syngeneic iliac crest allograft mixed with clinical bone-graft substitute and varying concentrations of antibiotics (n = 12 each): (1) control without any antibiotics, (2) low-dose vancomycin (14.3 mg/kg), (3) high-dose vancomycin (71.5 mg/kg), (4) low-dose tobramycin (28.6 mg/kg), and (5) high-dose tobramycin (143 mg/kg). Eight weeks postoperatively, fusion was evaluated via micro-computed tomography (µCT), manual palpation, and histological analysis, with blinding to treatment group. In the µCT analysis, fusion-mass volumes were measured for each rat. Each spine specimen (L4-L5) was rated (manual palpation score) on a scale of 2 to 0 (2 = fused, 1 = partially fused, and 0 = non-fused). RESULTS The mean fusion-mass volume on µCT (mm) was as follows: control, 29.3 ± 6.2; low-dose vancomycin, 26.3 ± 8.9; high-dose vancomycin, 18.8 ± 7.9; low-dose tobramycin, 32.7 ± 9.0; and high-dose tobramycin, 43.8 ± 11.9 (control versus high-dose vancomycin, p < 0.05; and control versus high-dose tobramycin, p < 0.05). The mean manual palpation score for each group was as follows: control, 1.46 ± 0.58; low-dose vancomycin, 0.86 ± 0.87; high-dose vancomycin, 0.68 ± 0.62; low-dose tobramycin, 1.25 ± 0.71; and high-dose tobramycin, 1.32 ± 0.72 (control versus high-dose vancomycin, p < 0.05). The histological analyses demonstrated a similar trend with regard to spinal fusion volume. CONCLUSIONS Intraoperative local application of vancomycin, particularly at a supraphysiological dosage, may have detrimental effects on fusion-mass formation. No inhibitory effect of tobramycin on fusion-mass formation was observed. CLINICAL RELEVANCE When spine surgeons decide to use intraoperative intrawound antibiotics in spinal fusion surgery, they should weigh the reduction in surgical site infection against a possible inhibitory effect on fusion.
Collapse
Affiliation(s)
- Wataru Ishida
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | - John Locke
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christina Holmes
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Timothy F Witham
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sheng-Fu L Lo
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
24
|
Fehring TK, Fehring KA, Hewlett A, Higuera CA, Otero JE, Tande A. What's New in Musculoskeletal Infection. J Bone Joint Surg Am 2019; 101:1237-1244. [PMID: 31318802 DOI: 10.2106/jbjs.19.00403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
| | | | | | | | - Jesse E Otero
- OrthoCarolina Hip & Knee Center, Charlotte, North Carolina
| | | |
Collapse
|
25
|
Potter BK. From Bench to Bedside: A Little Dab Will Do You Good? Topical Prevention of Surgical Site Infections. Clin Orthop Relat Res 2018; 476:2325-2327. [PMID: 30299287 PMCID: PMC6259908 DOI: 10.1097/corr.0000000000000521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 09/18/2018] [Indexed: 01/31/2023]
Affiliation(s)
- Benjamin K Potter
- B. K. Potter, Directorate for Surgical Services, Walter Reed National Military Medical Center & the Uniformed Services University-Walter Reed Department of Surgery, Bethesda, MD USA
| |
Collapse
|