Prevention Of Surgical Site Infection Following Open Spine Surgery: A Randomized Controlled Trial Of Intrawound Vancomycin At The National Hospital, Abuja.

Abstract

Objective: This study was carried out to determine the effectiveness of intrawound (local wound application) vancomycin powder in the prevention of surgical site infection following open spine surgery. Methods: This was a prospective, hospital-based, randomized controlled, interventional study.  Sixty-seven patients who met the inclusion criteria were randomized into either the Vancomycin group (33 patients) or the Control group (34 patients) using a preformed study proforma. All patients were followed up for 3 months for evidence of spinal SSI. Results: Seven cases of SSI occurred in the control group and none in the vancomycin group. This was statistically significant (p=0.001). The causative bacteria were Staphylococcus aureus (3, 43%), Pseudomonas aeruginosa (3, 43%), and Escherichia coli (1, 14%). There was a significantly prolonged postoperative hospital stay following SSI. the following variables were found to have statistically significant findings: posterior spine instrumentation (p=0.003), longer duration of surgery (>6 hours, p=0.003), and prolonged postoperative stay (p=0.001). Conclusion: Vancomycin is effective in prophylaxis against SSI following open spine surgery. Its use prevents prolonged hospitalization, complication, and morbidity arising from spinal SSI. Vancomycin powder should be used in open spine surgeries as an adjunct to intravenous antibiotic prophylaxis for the prevention of surgical site infections. Intrawound application of vancomycin is safe, as no case of systemic toxicity was recorded. We recommend the use of intrawound vancomycin powder as an adjunct to IV prophylactic antibiotics in all open posterior, instrumented spinal surgeries.