Efficacy of per operative use of powdered vancomycin in reduction of early post-operative superficial surgical site infection in single level prolapsed lumber intervertebral disc surgery

Authors

  • Tayeb Ahmmed Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
  • Dhiman Chowdhury Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
  • Kanij Fatima Department of Prosthodontics, Liberty Hospital (Pvt) Ltd, Dhaka, Bangladesh
  • K. Olinur Razib Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
  • Kazi Saiful Islam Department of Neurosurgery, Directorate General of Health Services (DGHS), Mohakhali, Dhaka, Bangladesh
  • M. Abdur Rahim Department of Neurosurgery, Directorate General of Health Services (DGHS), Mohakhali, Dhaka, Bangladesh
  • Muhammad Saiful Islam Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
  • Mariam Zaman SM Group, Gulshan, Dhaka, Bangladesh
  • Ariful Islam Joarder Department of Cardiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
  • Farid Raihan Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
  • Mohammad Shahnawaz Bari Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh

DOI:

https://doi.org/10.18203/2320-6012.ijrms20241531

Keywords:

CRP, ESR, PLID, TC-WBC, SSI

Abstract

Background: Decompression (fenestration and discectomy) of lumber disc herniation is one of the most common surgical procedures done by neurosurgeons. The aim of this study was to evaluate the efficacy of per operative use of powdered vancomycin in reduction of early post-operative superficial surgical site infection in single level prolapsed lumber intervertebral disc surgery.

Methods: This was a Quasi-experimental type of study carried out in the Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from October 2022 to September 2023.

Results: In this study, the mean age was 42.2±10.5 years, ranging from 20 to 60 years. The highest incidence of prolapsed lumbar intervertebral disc (PLID) was in the vancomycin group among patients aged 41-60, with a male-to-female ratio of 1.7:1. Most PLID cases (59.4%) occurred at the L4/5 level. Out of 32 patients, only four (no vancomycin group) had an ESR above 75 mm/hr. On the 30th postoperative day, significantly increased CRP levels and signs of infection were observed. Among those with purulent discharge, 50% had Staphylococcus aureus, 25% had Staphylococcus epidermidis, and 25% showed no pathogen growth.

Conclusions: In this study, we found that there is a significant effect of topical application of powdered vancomycin in addition to systemic antibiotic prophylaxis over the subcutaneous tissue following fenestration and discectomy in single level prolapsed lumber intervertebral disc and reduction in the incidence of superficial surgical site infection.

References

Cruse P. Wound infection surveillance. Revi Infect Dis. 1981;3(4):734-7.

Klevens RM, Edwards JR, Richards Jr CL, Horan TC, Gaynes RP, Pollock DA, et al. Estimating health care-associated infections and deaths in US hospitals, 2002. Publ Heal Rep. 2007;122(2):160-6.

Anderson DJ, Podgorny K, Berríos-Torres SI, Bratzler DW, Dellinger EP, Greene L, et al. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35(6):605-27.

Scott RD. The direct medical costs of healthcare-associated infections in US hospitals and the benefits of prevention. 2009.

Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR, Hospital Infection Control Practices Advisory Committee. Guideline for prevention of surgical site infection, 1999. Infect Contr Hosp Epidemiol. 1999;20(4):247-80.

Abdullah KG, Attiah MA, Olsen AS, Richardson A, Lucas TH. Reducing surgical site infections following craniotomy: examination of the use of topical vancomycin. J Neurosurg. 2015;123(6):1600-4.

Chiang HY, Herwaldt LA, Blevins AE, Cho E, Schweizer ML. Effectiveness of local vancomycin powder to decrease surgical site infections: a meta-analysis. Spine J. 2014;14(3):397-407.

Krizek TJ, Robson MC. Evolution of quantitative bacteriology in wound management. Am J Surg. 1975;130(5):579-84.

Elek SD, Conen PE. The virulence of Staphylococcus pyogenes for man. A study of the problems of wound infection. Brit J Experim Pathol. 1957;38(6):573.

Hranjec T, Swenson BR, Sawyer RG. Surgical site infection prevention: how we do it. Surg Infect. 2010;11(3):289-94.

Kang BU, Lee SH, Ahn Y, Choi WC, Choi YG. Surgical site infection in spinal surgery: detection and management based on serial C-reactive protein measurements. J Neurosurg: Spine. 2010;13(2):158-64.

Molinari RW, Khera OA, Molinari III WJ. Prophylactic intraoperative powdered vancomycin and postoperative deep spinal wound infection: 1,512 consecutive surgical cases over a 6-year period. Europ Spine Jo. 2012;21:476-82.

Machino M, Nakashima H, Ito K, Tsushima M, Ando K, Kobayashi K, et al. Influence of age and gender on intervertebral disk degeneration and height in the thoracolumbar spine. Spine surg Relat Res. 2022;6(4):379-87.

Ansary A, Mondle MS, Hossain MA. Abnormalities in plain x-ray findings of lumbosacral spine in prolapsed lumbar intervertebral disc. Medic Today. 2010;22(01):6-11.

Ozgen S, Konya D, Toktas OZ, Dagcinar A, Ozek MM. Lumbar disc herniation in adolescence. Pediatr Neurosurg. 2007;43(2):77-81.

Zare A, Sabahi M, Safari H, Kiani A, Schmidt MH, Arjipour M. Spinal surgery and subsequent ESR and WBC changes pattern: a single center prospective study. Kor J Neurotra. 2021;17(2):136.

Nehring SM, Goyal A, Patel BC. C-reactive protein. In: StatPearls. StatPearls Publishing, Treasure Island (FL); 2022.

van Gerven C, Eid K, Krüger T, Fell M, Kendoff D, Friedrich M, et al. Serum C-reactive protein and WBC count in conservatively and operatively managed bacterial spondylodiscitis. J Orthop Surg. 2021;29(1):2309499020968296.

Ravikumar V, Ho AL, Pendharkar AV, Sussman ES, Chow KK, Li G. The use of vancomycin powder for surgical prophylaxis following craniotomy. Neurosurg. 2017;80(5):754-8.

Korinek AM. Risk factors for neurosurgical site infections after craniotomy: a prospective multicenter study of 2944 patients. Neurosurg. 1997;41(5):1073-81.

Chiang HY, Kamath AS, Pottinger JM, Greenlee JD, Howard MA, Cavanaugh JE, et al. Risk factors and outcomes associated with surgical site infections after craniotomy or craniectomy. J Neurosurg. 2014;120(2):509-21.

Cong Y, Yang S, Rao X. Vancomycin resistant Staphylococcus aureus infections: A review of case updating and clinical features. J Adv Res. 2019;21:169-76.

Heller A, McIff TE, Lai SM, Burton DC. Intrawound vancomycin powder decreases staphylococcal surgical site infections after posterior instrumented spinal arthrodesis. Clin Spine Surg. 2015;28(10):E584-9.

Downloads

Published

2024-05-31

How to Cite

Ahmmed, T., Chowdhury, D., Fatima, K., Razib, K. O., Islam, K. S., Rahim, M. A., Islam, M. S., Zaman, M., Joarder, A. I., Raihan, F., & Bari, M. S. (2024). Efficacy of per operative use of powdered vancomycin in reduction of early post-operative superficial surgical site infection in single level prolapsed lumber intervertebral disc surgery. International Journal of Research in Medical Sciences, 12(6), 1879–1886. https://doi.org/10.18203/2320-6012.ijrms20241531

Issue

Section

Original Research Articles