Topical vancomycin for surgical prophylaxis in non-instrumented pediatric spinal surgeries.

Cannon, John G. D.; Ho, Allen L.; Mohole, Jyodi; Pendharkar, Arjun V.; Sussman, Eric S.; Cheshier, Samuel H.; Grant, Gerald A.

Study design: Retrospective cohort study.Objective: To determine if topical vancomycin irrigation reduces the incidence of post-operative surgical site infections following pediatric spinal procedures.Summary of background data: Surgical site infections (SSIs) following spinal procedures performed in pediatric patients represent a serious complication. Prophylactic use of topical vancomycin prior to closure has been shown to be effective in reducing incidence of SSIs in adult spinal procedures. Non-instrumented cases make up the majority of spinal procedures in pediatric patients, and the efficacy of prophylactic topical vancomycin in these procedures has not previously been reported.Methods: This retrospective study reviewed all non-instrumented spinal procedures performed over a period from 05/2014-12/2016 for topical vancomycin use, surgical site infections, and clinical variables associated with SSI. Topical vancomycin was utilized as infection prophylaxis, and applied as a liquid solution within the wound prior to closure.Results: Ninety-five consecutive, non-instrumented, pediatric spinal surgeries were completed between 01/2015 and 12/2016, of which the last 68 utilized topical vancomycin. There was a 11.1% SSI rate in the non-topical vancomycin cohort versus 0% in the topical vancomycin cohort (P = 0.005). The number needed to treat was 9. There were no significant differences in risk factors for SSI between cohorts. There were no complications associated topical vancomycin use.Conclusions: Routine topical vancomycin administration during closure of non-instrumented spinal procedures can be a safe and effective tool for reducing SSIs in the pediatric neurosurgical population.

SURGICAL site infections; SPINAL surgery; PEDIATRIC surgery; VANCOMYCIN; ENTEROCOCCAL infections; PREVENTIVE medicine

Child's Nervous System, 2019, Vol 35, Issue 1, p107

0256-7040

Academic Journal

10.1007/s00381-018-3881-z