PMID- 26749522
OWN - NLM
STAT- MEDLINE
DCOM- 20161020
LR  - 20161230
IS  - 1875-9114 (Electronic)
IS  - 0277-0008 (Linking)
VI  - 36
IP  - 1
DP  - 2016 Jan
TI  - A Retrospective Study on the Protective Effects of Topical Vancomycin in Patients 
      Undergoing Multilevel Spinal Fusion.
PG  - 19-25
LID - 10.1002/phar.1678 [doi]
AB  - BACKGROUND: Topical vancomycin may be an effective intervention to decrease the 
      risk of postoperative surgical site infections (SSIs). The primary objective of 
      this study was to evaluate the impact of topical vancomycin with intravenous (IV) 
      cefazolin compared with IV cefazolin alone on the incidence of SSI in 
      instrumented multilevel spinal fusion (MLSF) surgery. METHODS: This was a 
      retrospective cohort study of patients 18 years and older who underwent 
      instrumented MLSF surgery between January 1, 2010, and July 31, 2014. Patients 
      who underwent anterior cervical diskectomy and fusion, had spine surgery within 3 
      months prior to index case, received antibiotics other than IV cefazolin prior to 
      surgery, or had preoperative length of stay longer than 5 days were excluded. 
      SSIs were identified using Centers for Disease Control and Prevention National 
      Healthcare Safety Network definitions. Summary statistics were computed. 
      Variables found to be associated with increased risk of SSI through univariate 
      analysis were included in a multivariate analysis. RESULTS: Among 326 patients, 
      29 (8.9%) developed an SSI. Univariate analysis showed a trend toward decreased 
      SSI incidence in the cohort receiving topical vancomycin with IV cefazolin 
      compared with IV cefazolin alone, although this was not statistically significant 
      ([6/116] 5.2% vs [23/210] 11.0%, p = 0.08). Topical vancomycin was associated 
      with a protective effect against SSI in the multivariate analysis (odds ratio 
      [OR] 0.26, p = 0.02). Significant risk factors for the development of SSI 
      included female sex (OR 3.3, p = 0.01), increasing invasiveness score (p < 0.01), 
      and diabetes mellitus (OR 5.1, p < 0.01). CONCLUSION: Topical vancomycin 
      administered in addition to IV cefazolin was associated with a decreased risk of 
      SSI in high-risk MLSF patients. Female patients and those with diabetes mellitus 
      were at higher risk of developing postsurgical infection. Further prospective 
      studies are needed to confirm these results and to define the most clinically 
      effective dose of topical vancomycin in this patient population.
CI  - (c) 2016 Pharmacotherapy Publications, Inc.
FAU - Gaviola, Marian L
AU  - Gaviola ML
AD  - Department of Pharmacotherapy, University of North Texas System College of 
      Pharmacy, Fort Worth, Texas.
FAU - McMillian, Wesley D
AU  - McMillian WD
AD  - Department of Pharmacy, The University of Vermont Medical Center, Burlington, 
      Vermont.
FAU - Ames, Suzanne Elizabeth
AU  - Ames SE
AD  - Department of Orthopedics & Rehabilitation, The University of Vermont Medical 
      Center, Burlington, Vermont.
FAU - Endicott, Jeffrey A
AU  - Endicott JA
AD  - Department of Pharmacy, The University of Vermont Medical Center, Burlington, 
      Vermont.
FAU - Alston, Wallace Kemper
AU  - Alston WK
AD  - Department of Medicine, Infectious Disease Unit, The University of Vermont 
      Medical Center, Burlington, Vermont.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20160109
PL  - United States
TA  - Pharmacotherapy
JT  - Pharmacotherapy
JID - 8111305
RN  - 0 (Anti-Bacterial Agents)
RN  - 6Q205EH1VU (Vancomycin)
RN  - IHS69L0Y4T (Cefazolin)
SB  - IM
MH  - Administration, Intravenous
MH  - Administration, Topical
MH  - Adult
MH  - Aged
MH  - Anti-Bacterial Agents/administration & dosage/*therapeutic use
MH  - Cefazolin/administration & dosage/therapeutic use
MH  - Drug Therapy, Combination
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Spinal Fusion/adverse effects/*methods
MH  - Surgical Wound Infection/*prevention & control
MH  - Vancomycin/administration & dosage/*therapeutic use
OTO - NOTNLM
OT  - fusion
OT  - infection
OT  - prophylaxis
OT  - spine
OT  - surgical site infection
OT  - vancomycin
EDAT- 2016/01/11 06:00
MHDA- 2016/10/21 06:00
CRDT- 2016/01/11 06:00
PHST- 2016/01/11 06:00 [entrez]
PHST- 2016/01/11 06:00 [pubmed]
PHST- 2016/10/21 06:00 [medline]
AID - 10.1002/phar.1678 [doi]
PST - ppublish
SO  - Pharmacotherapy. 2016 Jan;36(1):19-25. doi: 10.1002/phar.1678. Epub 2016 Jan 9.