Prophylactic Topical Antibiotics in Fracture Repair and Spinal Fusion

Table 1

Summary of infection rates and methodology of studies of instrumented spinal procedure.

Authors/year	Study design/method of controlling for bias	No. of pts	Age range of pts	Included spinal diagnoses/procedures	Intervention	Wound infection rates in treatment group	Wound infection rates in control group
Adhikari et al. 2020 [20]^‡	RC/NR	141	Adults	Deformity, degenerative, trauma, neoplastic/posterior instrumented fusion	Vancomycin powder 1 g	3.53% (3/85)	1.79% (1/56)
Caroom et al. 2013 [21]	RC/NR	112	NR	Cervical spondylotic myelopathy/posterior instrumented fusion	Vancomycin powder 1 g	0% (0/40)	15.28% (11/72)
Dewan et al. 2013 [22]^a,	RC/NR	455	NR	Degenerative/posterior spinal fusion	Vancomycin powder 1 g	0% (0/137)	5.66% (18/318)
Ehlers et al. 2016 [23]^b	PC/propensity score matching	6910	NR	Instrumented cervical or lumbar fusion	Intrawound antibiotics (type and dose NR)	0.93% (32/3455)	1.30% (45/3455)
Emohare et al. 2014 [24]^c	RC/multivariate analysis, pseudo-randomization by surgeon^d	200	NR	Degenerative/posterior instrumented thoracic, thoracolumbar, lumbar fusion	Vancomycin powder 1 g	0% (0/78)	3.28% (4/122)
Gaviola et al. 2016 [25]	RC/multivariate analysis	326	40–71	Instrumented multilevel fusion	Vancomycin powder 2 g	5.17% (6/116)	11.0% (23/210)
Haimoto et al. 2018 [26]	RC/NR	515	18 and above	Posterior instrumented cervical, thoracic, lumbar fusion	Vancomycin powder 1 g	0% (0/247)	5.60% (15/268)
Heller et al. 2015 [27]^‡	RC/NR	683	NR	Degenerative, deformity, neoplastic, others/posterior instrumented fusion	Vancomycin powder 0.5–2 g	2.63% (9/342)	5.28% (18/341)
Hey et al. 2017 [28]	RC/multivariate analysis, pseudo-randomization	389	11–85	Degenerative, trauma, neoplastic/open instrumentation	Vancomycin powder 1 g	0.85% (1/117, 1 deep)	6.25% (17/272, 10 deep, 7 superficial)
Horii et al. 2018 [29]^b	RC/propensity score matching	1014	15 and above	Degenerative, deformity, trauma, neoplastics/posterior instrumentation	Vancomycin powder 1–2 g	1.58% (8/507)	1.78% (9/507)
Kim et al. 2013 [30]	RC/logistic regression, multivariate analysis, and cox regression	74	NR	Spinal instability/posterior instrumented fusion	Vancomycin powder 1 g	0% (0/34)	12.5% (5/40, 3 deep, 2 superficial)
Kunakornsawat et al. 2019 [31]^‡	RCT/randomizations	400	11–82	Trauma, degenerative, congenital, neoplastic, infectious/posterior instrumented thoracic or lumbosacral fusions	Vancomycin powder 1–2 g	3.40% (9/265)	2.96% (4/135)
Lemans et al. 2017 [32]	RC/NR	505	Adults	Open posterior instrumentation	Vancomycin powder 1–2 g	4.44% (8/180, 5 deep, 3 superficial)	13.85% (45/325, 31 deep, 14 superficial)
Liu et al. 2015 [33]^‡	RC/NR	334	53.5–74	Deformity, degenerative, neoplastic/posterior instrumentation	Vancomycin powder 0.5–2 g	2.78% (5/180)	7.14% (11/154)
Ludwig do nascimento et al. 2020 [34]	RCT/randomization, double blinding	96	17–74	Degenerative, trauma/thoracolumbar spine arthrodesis	20 ml of saline with 2 g of diluted vancomycin	8.16% (4/49)	8.51% (4/47)
Martin et al. 2014 [35]^b,‡	RC/logistic regression, propensity score matching	306	18 and above	Deformity/posterior instrumented fusion	Vancomycin powder 2 g	5.12% (8/156)	5.33% (8/150)
Ogihara et al. 2021 [36]^‡	RC/multivariable analysis	2913	18–93	Degenerative/posterior instrumented fusion in the thoracic/lumbar spines	Vancomycin powder	1.52% (7/460)	1.14% (28/2453)
Oktay et al. 2020 [37]	RC/NR	209	14–90	Degenerative, trauma, neoplastic, revision/posterior instrumentation	Vancomycin powder 1 g	1.96% (2/102, 1 deep, 1 superficial)	6.54% (7/107, 4 deep, 3 superficial)
O’Neill et al. 2011 [38]	RC/pseudo-randomization	110	18 and above	Trauma/posterior instrumented fusion	Vancomycin powder 1 g	0% (0/56)	12.96% (7/54, 5 deep, 2 superficial)
Satake et al. 2015 [39]^‡,	PC/NR	207	Not given	Open posterior instrumented thoracic, lumbar fusion	Vancomycin powder with fibrin glue (dosage NR)	0% (0/59)	6.08% (9/148)
Scheverin et al. 2015 [40]	RC/pseudo-randomization	513	18–78	Degenerative/posterior instrumented lumbar fusion	Vancomycin powder 1 g mixed with bone graft	1.29% (3/232)	4.98% (14/281)
Strom et al. 2013 [41]	RC/NR	171	Adult patients	Degenerative, infectious, neoplastic, trauma/posterior cervical instrumented fusion	Vancomycin powder 1 g	2.53% (2/79)	10.87% (10/92)
Strom et al. 2013 [42]	RC/stratification	165	NRs	Degenerative, infectious, neoplastic, trauma/lumbar laminectomy and posterior instrumented fusion	Vancomycin powder 1 g	0% (0/88)	11.69% (9/77)
Suh et al. 2015 [43]	RCT/NR	86	23–83	Degenerative/posterior instrumented lumbar fusion	Vancomycin powder 2 g	4.65% (2/43)	2.33% (1/43)
Sweet et al. 2011 [44]^‡,	RC/NR	1732	12–86	Posterior instrumented thoracolumbar fusions	Vancomycin powder 2 g	0.22% (2/911)	2.56% (21/821)
Takeuchi et al. 2018 [45]^d	RCT/randomization, blinding	230	NR	Deformity, degenerative, trauma/thoracic, lumbar fusion	Vancomycin powder 1 g	1.72% (2/116, 1 deep, 1 superficial)	2.63% (3/114, 1 deep, 2 superficial)
Takeuchi et al. 2019 [46]	RC/NR	668	16–89	Degenerative, fracture/posterior spinal instrumentation	Vancomycin powder 1 g	0.32% (1/314)	2.54% (9/354)
Theologis et al. 2014 [47]	RC/NR	215	18–88	Deformity/fusion greater than 3 levels	Vancomycin powder 2 g	2.65% (4/151)	10.93% (7/64)
Tofuku et al. 2012 [48]^‡,	RC/NR	384	7–89	Degenerative, neoplastic, trauma, infectious/spinal instrumentation	0.5 g Vancomycin-impregnated fibrin sealant	0% (0/196)	5.85% (11/188)
Tubaki et al. 2013 [49]^‡	RCT/randomization	606	3–84	Listhesis, disc prolapse/open instrumentation	Vancomycin powder 1 g	1.99% (6/302)	1.97% (6/304)

Abbreviations: No., number; pts, patients; RCT, randomized controlled trial; PC, prospective cohort; RC, retrospective cohort; NR, not reported. ^aWe included only deep SSI that occurred in fusion cases. Superficial SSI were excluded because the paper reports that 5 occurred in both control and treatment groups, but the paper did not discern whether these occurred in instrumented or noninstrumented cases. ^bThere is another paper by O’Neill et al. that looked at only the spine trauma cases, but Dewan et al. look at the same trauma cases plus degenerative spine disease cases. The numbers included pertain to only the degenerative spine disease cases. ^cSample size reflects the propensity score matched cohorts. ^gControl group received ampicillin powder. ^‡Only deep infections were reported in this study. Studies showed a significant difference between the control and treatment groups.