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Nickalus R. Khan, Clinton J. Thompson, Michael DeCuypere, Jonathan M. Angotti, Erick Kalobwe, Michael S. Muhlbauer, Francis X. Camillo and Paul Klimo Jr.

involved in SSI after spine surgery are gram-positive organisms, such as Staphylococcus aureus and Staphylococcus epidermidis . 18 , 32 The use of preoperative antibiotics to target these bacteria, including intravenous cephalosporins and thorough skin preparation, is a routine measure in controlling SSIs. Despite specifically targeting gram-positive organism cell wall synthesis, the routine use of intravenous vancomycin has not been shown to be more effective than intravenous cephalosporins in preventing SSIs. 1 , 22 The use of vancomycin powder has been

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Vincent Dodson, Neil Majmundar, Vanessa Swantic and Rachid Assina

S urgical site infection (SSI) remains a significant concern, both in terms of patient morbidity and cost to the healthcare system. 8 , 21 The rate of postoperative wound infection following spine surgery in particular has been estimated to be between 2% and 13%. 7 , 28 , 29 As such, decreasing the rate of infection with vancomycin powder has typically become the standard of care for instrumented spine surgeries in most institutions in the United States. Several studies have shown that the rate of infections decreases with the use of vancomycin powder, but the

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Shoichi Haimoto, Ralph T. Schär, Yusuke Nishimura, Masahito Hara, Toshihiko Wakabayashi and Howard J. Ginsberg

D espite the use of perioperative systemic antibiotic prophylaxis, surgical site infections (SSIs) remain a serious complication in spine surgery, particularly in instrumented spinal fusion. SSIs can have a profound negative impact on patient outcomes and burden the health care system by leading to revision surgery, lengthy use of systemic antibiotics, and prolonged hospitalization. 11 , 18 , 25 , 26 In recent years the use of intrawound vancomycin powder in spine surgery has emerged as a promising method to address these concerns. Many, mainly retrospective

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Joel R. Martin, Owoicho Adogwa, Christopher R. Brown, Maragatha Kuchibhatla, Carlos A. Bagley, Shivanand P. Lad and Oren N. Gottfried

require more hospitalizations, surgical procedures, and resultant increased economic burden. 25 Furthermore, patients who develop SSIs have an elevated mortality risk. 1 , 6 , 7 Given the incidence of deep wound infections, several authors explored and subsequently published their results on locally applied prophylactic vancomycin antibiotic powder, in addition to systemic antibiotics, to reduce postoperative spinal SSIs. 2–4 , 9 , 13–17 , 20–22 , 24 Perioperative vancomycin powder is an attractive option for additional prophylaxis against postoperative SSI due to

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Marco C. Mendoza, Kevin A. Sonn, Abhishek S. Kannan, Sharath S. Bellary, Sean M. Mitchell, Gurmit Singh, Christian Park, Chawon Yun, Stuart R. Stock, Erin L. Hsu and Wellington K. Hsu

H istorically , local application of antibiotics during surgery has been limited to the treatment of periprosthetic joint infections. However, since 2011, a number of clinical studies have demonstrated the efficacy of intrawound vancomycin powder application in the reduction of postoperative infection rates in spine surgery. 4 , 22 , 25 , 26 , 27 This strategy aims to eradicate bacteria through achievement of local supratherapeutic antibiotic levels for a short period of time postoperatively. 2 , 27 Its local application avoids the systemic side effects

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Saniya S. Godil, Scott L. Parker, Kevin R. O'Neill, Clinton J. Devin and Matthew J. McGirt

who underwent posterior spinal fusion and found a reduction in SSI from 2.6% to 0.2% in the cohort that received vancomycin powder in addition to IV cephalosporin. Similarly, our group has previously reported that local application of vancomycin powder in spine trauma patients undergoing posterior spinal fusion leads to a significant reduction in the infection rate from 13% to 0%. 28 To date, none of the studies have evaluated the cost benefit of prophylactic use of local antibiotics. In light of this, using the same cohort of spine trauma patients, 28 we set out

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Ramamani Mariappan, Pirjo Manninen, Eric M. Massicotte and Anuj Bhatia

the use of topically applied antibiotics to the area of surgery. The use of topical vancomycin during spine instrumentation has been shown to decrease the incidence of wound infection. 12 Intravenous vancomycin is well known to have adverse effects that include nephrotoxicity, ototoxicity, decrease in blood cell counts, and hypersensitivity reactions (anaphylactic and anaphylactoid). We report a case of circulatory collapse after the application of vancomycin powder into the surgical wound during thoracolumbar spine surgery for tumor resection. Written consent for

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Owoicho Adogwa, Aladine A. Elsamadicy, Amanda Sergesketter, Victoria D. Vuong, Ankit I. Mehta, Raul A. Vasquez, Joseph Cheng, Carlos A. Bagley and Isaac O. Karikari

procedures, locally applying prophylactic antibiotics (i.e., vancomycin powder) was introduced as an adjunct to standard systemic antibiotic prophylaxis with the hope of decreasing postoperative infection rates. Vancomycin powder provides broad coverage and is available at a low cost, making it an appealing option as an adjunct for perioperative prophylaxis against postoperative SSIs. Many studies have shown that prophylactic application of vancomycin powder in addition to standard systemic antibiotic prophylaxis leads to a reduction of postoperative deep and superficial

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The effect of vancomycin powder on human dural fibroblast culture and its implications for dural repair during spine surgery

Presented at the 2016 AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves

Ezequiel Goldschmidt, Jorge Rasmussen, Joseph D. Chabot, Gurpreet Gandhoke, Emilia Luzzi, Lina Merlotti, Romina Proni, Mónica Loresi, D. Kojo Hamilton, David O. Okonkwo, Adam S. Kanter and Peter C. Gerszten

, 2 and mupirocin nasal ointments 10 have been effective in reducing the incidence of SSI after spinal surgery. The topical application of lyophilized vancomycin (LV) to the surgical bed following spinal surgery can achieve very high concentrations in the surgical site with minimal systemic repercussions. 6 , 18 , 19 Although 3 recently published meta-analyses have described a decrease in the incidence of SSI after spine surgery with the use of topical vancomycin powder applied before closure, 1 , 12 , 21 the true benefit of this practice is still controversial

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Kingsley O. Abode-Iyamah, Hsiu-Yin Chiang, Nolan Winslow, Brian Park, Mario Zanaty, Brian J. Dlouhy, Oliver E. Flouty, Zachary D. Rasmussen, Loreen A. Herwaldt and Jeremy D. Greenlee

.e., prosthetic implants) during cranioplasty, and general medical debilitation after significant trauma. SSIs after cranioplasty can cause significant morbidity, and treatment often involves removing the bone or prosthetic flap followed by long-term antibiotic therapy. Subsequent reoperation to correct the cranial defect is delayed several months to reduce the risk of a second infection. 15 Given the morbidity associated with SSIs after neurosurgical and orthopedic procedures, several groups have assessed the use of intrawound vancomycin powder (VP) for preventing SSIs. Most