Local application of vancomycin powder to prevent spinal surgical site infections: a meta-analysis

English Keywords:Spine surgery  Surgical site infections  Local application  Vancomycin powder  Meta-analysis

English Abstract:

  【Abstract】 Objectives: To estimate the effectiveness of local application of vancomycin powder(VP) to prevent surgical site infections(SSIs) after spine surgery. Methods: A computer-based online search of Medline(Pubmed), Embase, CBM and CNKI for articles published before April 1st, 2015 was performed to collect comparative studies of intrawound vancomycin in spine surgery. Two reviewers independently screened eligible articles based on inclusion and exclusion criteria, assessed study quality and extracted data. Revman 5.3 software was used for data analysis. Results: 11 articles which encompassed 5,155 surgical patients were finally identified for meta-analysis, including 10 respective cohort studies and 1 randomised controlled trial. According to the information given by the literature identified, three subgroup analysis was conducted that respectively compared the effects of topical application of VP on SSIs rates of spinal routine operation, corrective operation, instrumented and noninstrumented operation, and rates of superficial and deep SSIs. The results suggested that local application of VP could significantly reduce the risk of SSIs after spinal routine operation(OR=0.27, 95% CI 0.12-0.57, P=0.0007) and instrumented operation(OR=0.33, 95% CI 0.17-0.66, P=0.001), and could effectively prevent deep SSIs(OR=0.33, 95% CI 0.14-0.77, P=0.01), while the influence on superficial SSIs and infections after corrective operation and noninstrumented operation were still unclear(P>0.05). Conclusions: The local application of VP appears to protect against deep SSIs and infections after spinal routine operation and instrumented operation.