Journal article
Effectiveness of local vancomycin powder to decrease surgical site infections: a meta-analysis
The spine journal, Vol.14(3), pp.397-407
03/01/2014
DOI: 10.1016/j.spinee.2013.10.012
PMID: 24373682
Abstract
Some surgeons use systemic vancomycin to prevent surgical site infections (SSIs), but patients who do not carry methicillin-resistant Staphylococcus aureus have an increased risk of SSIs when given vancomycin alone for intravenous prophylaxis. Applying vancomycin powder to the wound before closure could increase the local tissue vancomycin level without significant systemic levels. However, the effectiveness of local vancomycin powder application for preventing SSIs has not been established.
Our objective was to systematically review and evaluate studies on the effectiveness of local vancomycin powder for decreasing SSIs.
Meta-analysis.
We included observational studies, quasi-experimental studies, and randomized controlled trials of patients undergoing surgical procedures that involved vancomycin powder application to surgical wounds, reported SSI rates, and had a comparison group that did not use local vancomycin powder.
The primary outcome was postoperative SSIs. The secondary outcomes included deep incisional SSIs and S. aureus SSIs.
We performed systematic literature searches in PubMed, the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects, the Cochrane Central Register of Controlled Trials via Wiley, Scopus (including EMBASE abstracts), Web of Science, ClinicalTrials.gov, BMC Proceedings, ProQuest Dissertation, and Thesis in Health and Medicine, and conference abstracts from IDWeek, the Interscience Conference on Antimicrobial Agents and Chemotherapy, the Society for Healthcare Epidemiology of America, and the American Academy of Orthopedic Surgeons annual meetings, and also the Scoliosis Research Society Annual Meeting and Course. We ran the searches from inception on May 9, 2013 with no limits on date or language. After reviewing 373 titles or abstracts and 22 articles in detail, we included 10 independent studies and used a random-effects model when pooling risk estimates to assess the effectiveness of local vancomycin powder application for preventing SSIs, the outcome of interest. We used the I2-index, Q-statistic, and corresponding p value to assess the heterogeneity of the risk estimates, and funnel plots to assess publication bias.
We included seven quasi-experimental studies, two cohort studies, and one randomized controlled trial, encompassing 5,888 surgical patients. The pooled effects showed that applying local vancomycin powder was significantly protective against SSIs (pooled odds ratio [pOR] 0.19; 95% confidence interval [CI] 0.09–0.38), deep incisional SSIs (pOR 0.23; 95% CI 0.09–0.57), and SSIs caused by S. aureus (pOR 0.22; 95% CI 0.08–0.58). However, significant heterogeneity was present for studies evaluating all SSIs or deep incisional SSIs. When we pooled the risk estimates from the eight studies that assessed patients undergoing spinal operations, vancomycin powder remained significantly protective against SSIs (pOR 0.16; 95% CI 0.09–0.30), deep incisional SSIs (pOR 0.18; 95% CI 0.09–0.36), and SSIs caused by S. aureus (pOR 0.11; 95% CI 0.03–0.36). The pooled ORs from studies of spinal operations were lower than those for all studies and the estimates from spinal operation studies were homogeneous. However, there was evidence of publication bias.
Local administration of vancomycin powder appears to protect against SSIs, deep incisional SSIs, and S. aureus SSIs after spinal operations. Large, high-quality studies should be performed to evaluate this intervention before it is used routinely.
Details
- Title: Subtitle
- Effectiveness of local vancomycin powder to decrease surgical site infections: a meta-analysis
- Creators
- Hsiu-Yin Chiang - Department of Internal Medicine, The University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USALoreen A Herwaldt - Department of Internal Medicine, The University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USAAmy E Blevins - Hardin Library for the Health Sciences, The University of Iowa, 100 Hardin Library for the Health Sciences (HLHS), Iowa City, IA 55242, USAEdward Cho - Department of Internal Medicine, The University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USAMarin L Schweizer - Department of Internal Medicine, The University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA
- Resource Type
- Journal article
- Publication Details
- The spine journal, Vol.14(3), pp.397-407
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.spinee.2013.10.012
- PMID
- 24373682
- ISSN
- 1529-9430
- eISSN
- 1878-1632
- Grant note
- Agency for Healthcare Research and Quality
- Language
- English
- Date published
- 03/01/2014
- Academic Unit
- Infectious Diseases; Epidemiology; General Internal Medicine; Internal Medicine
- Record Identifier
- 9984094548602771
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