Monday, January 13, 2014

In the wound Vancomycin to attack surgical contamination

Intrawound Vancomycin Powder Eradicates Surgical Wound Contamination: An in Vivo Rabbit Study

In a recent post we pointed out that frequent contamination of the wound at the time of surgery could be expected and that one source of the bacteria was the dermal edge of the wound.

These authors pointed out that surgical site infection remains a complication of spine surgery despite routine use of intravenous prophylactic antibiotics. They used a rabbit model to  assess the efficacy of intrawound vancomycin powder in eradicating a known bacterial surgical site contamination with vancomycin-sensitive Staphylococcus aureus.

The bacterial cultures of the surgical site tissues were negative for all ten vancomycin-treated rabbits and positive for all ten control rabbits (p < 0.0001). Bacterial growth occurred in thirty-nine of forty samples from the control group but in zero of forty samples from the vancomycin group (p < 0.0001).
They concluded that their rabbit spine-infection model, intrawound vancomycin powder in combination with preoperative cefazolin eliminated S. aureus surgical site contamination. All rabbits that were managed with only prophylactic cefazolin had persistent S. aureus contamination. The authors point out that topical application of Vancomycin without beads or other vehicle enabled high early wound levels while avoiding residual foreign bodies and systemic toxicity risk.

We know of no reports of the use of topical Vancomycin powder in shoulder surgery, but apparently it is often used in spine surgery as prophylaxis as shown here, here and here