Meta-Analysis Of Topical Vancomycin Powder For Prevention Of Postoperative Infections In Spinal Surgical Sites

Background:Surgical site infections(SSIs)are a serious complication of spinal surgery,and can lead to catastrophic damage and a financial burden to patients.Since it was reported that topical vancomycin powder could reduce the incidence of SSIs in the spine,many scholars began to pursue the use of vancomycin powder.However,its efficacy has been questioned and has not been demonstrated until now.Objective:To systematically evaluate the efficacy of topical vancomycin powder in reducing the incidence of infections at surgical sites in the spine.Methods:All available literature regarding the topical use of vancomycin powder to prevent postoperative spinal infections was retrieved from the MEDLINE,EMBASE,and Cochrane databases starting from the creation date and up until September 2018.Two researchers independently screened the studies for their inclusion/exclusion criteria,evaluated their quality,extracted the data,and then analyzed the data using Revman 5.3 software.Results:A total of 23 studies involving 17,757 patients were reviewed.The combined odds ratio showed that topical use of vancomycin powder was effective for reducing the incidence of spinal SSIs(OR: 0.51,P = 0.0002)without affecting its efficacy in the treatment of deep infections(OR: 0.56,P = 0.0002).When used in an implant internal fixation procedure,however,topical vancomycin powder also can relieve SSIs(OR:0.48,P=0.003).In a sub-group analysis,vancomycin powder at a dose of 1 g(OR: 0.38,P = 0.0001)or 2 g(OR: 0.57,P = 0.02)reduced the incidence of spinal SSIs,but did not effectively prevent spinal SSIs when it was administered as Nonquantitative therapy(0.5-2 g)(OR: 0.76,P = 0.55).Conclusion:Topical administration of vancomycin powder can reduce the incidence of spinal SSIs to a certain extent by significantly preventing deep infections.Moreover,it can significantly decrease the incidence of SSIs when used in implanted internal fixation.Considering that adverse reactions to topical vancomycin are very rare,the topical use of vancomycin powder has some clinical value for preventing spinal SSIs when applied prior to closing the surgical wound.Due to the limited number of articles included in this study,additional large-scale and high quality studies are needed to provide more reliable clinical evidence.