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Intravenous Vancomycin to Prevent Spine Surgical Site Infections: Impact and Complications of A New Prophylaxis Protocol At A Large Pediatric Spine Center

Saturday, October 20, 2012: 1:00 PM
Melrose (Hilton Riverside)
Wajdi W. Kanj, BS, Melissa A. Gunderson, BA, Keith D. Baldwin, MD, MPH, MSPT and John M. Flynn, MD, Department of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, PA

Purpose

Following an increase in the public reporting of the prevalence of resistant pathogens, hospitals around the nation have focused on efforts to reduce surgical site infections. As an example, standard vancomycin prophylaxis has been added for pathogens not covered by first generation cephalosporins. However, vancomycin requires a one hour infusion prior to skin incision through a dedicated intravenous (IV) line. After the implementation of a new multidisciplinary protocol mandating the addition of vancomycin to the standard prophylactic regimen for all spine surgery patients at our hospital, we sought to identify peri-operative benefits and problems related to this change in protocol.

Methods

We reviewed consecutive patients undergoing spine surgery after the institution of a new antibiotic protocol, specifically noting demographics, surgery details, the type of antibiotic used, immediate adverse events, and 30-day infection rates. 

Results

Seventy-five consecutive patients received adjunctive, prophylactic IV vancomycin in addition to standard antibiotic regimens for spine surgery while 67 patients received only standard prophylactic antibiotics. There was a much higher rate of adverse events in the adjunctive vancomycin group, including: red man syndrome (3 patients), itching and rash (7 patients), hypotensive episodes (2 patients), and IV infiltrations causing operative delay (4 patients). In the control group, there were four episodes of itching or rash, no pre-operative IV infiltrations, and no episodes of hypotension. There was no statistically significant difference in the rate of 30-day surgical site infections between the two groups (3 cases in the vancomycin group and 4 in the control group).

Conclusion

The use of IV vancomycin prophylaxis prior to spine surgery is associated with an increased risk of peri-operative adverse events including red man syndrome, IV infiltrations, itching, rash and hypotensive episodes. We found no noticeable difference in the rate of surgical site infections with the addition of vancomycin to standard antibiotic prophylaxis regimens. After the implementation of a non-selective, mandatory vancomycin prophylaxis protocol for spine surgery patients, an increased incidence of adverse events was noted, and the protocol has subsequently been abandoned.