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  • Title: Should we add vancomycin antibiotic powder to prevent post operative infection in spine surgery?
    Author: López M, Molina M.
    Journal: Medwave; 2015 Jun 11; 15 Suppl 1():e6160. PubMed ID: 26079136.
    Abstract:
    Intravenous antibiotic prophylaxis is routinely administered to prevent surgical site infection in spinal surgery. Adding intrawound vancomycin powder before surgical closure might further decrease infection risk. However, its use is controversial. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified six systematic reviews that considered 16 studies, including one randomized controlled trial. We combined the evidence using meta-analysis and generated a summary of findings table following the GRADE approach. We concluded vancomycin probably does not decrease the risk of infection in low risk surgery, but there is uncertainty about its effects in populations or surgeries with a higher risk because the certainty of the evidence is very low. La profilaxis antibiótica endovenosa es de uso rutinario para la prevención de infección postoperatoria en cirugía de columna. Se ha planteado que la aplicación de vancomicina en polvo en el campo quirúrgico previo al cierre por planos podría tener un efecto adicional, sin embargo, su uso es controvertido. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos seis revisiones sistemáticas que en conjunto consideran 16 estudios pertinentes, incluyendo un estudio controlado aleatorizado. Realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. Se concluye que el uso de vancomicina probablemente no disminuye el riesgo de infección en cirugías de bajo riesgo, pero existe incertidumbre sobre el efecto en poblaciones o cirugías con un riesgo mayor porque la certeza de la evidencia es muy baja.
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