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Topical vancomycin for surgical prophylaxis in non-instrumented pediatric spinal surgeries

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Abstract

Study design

Retrospective cohort study.

Objective

To determine if topical vancomycin irrigation reduces the incidence of post-operative surgical site infections following pediatric spinal procedures.

Summary of background data

Surgical site infections (SSIs) following spinal procedures performed in pediatric patients represent a serious complication. Prophylactic use of topical vancomycin prior to closure has been shown to be effective in reducing incidence of SSIs in adult spinal procedures. Non-instrumented cases make up the majority of spinal procedures in pediatric patients, and the efficacy of prophylactic topical vancomycin in these procedures has not previously been reported.

Methods

This retrospective study reviewed all non-instrumented spinal procedures performed over a period from 05/2014–12/2016 for topical vancomycin use, surgical site infections, and clinical variables associated with SSI. Topical vancomycin was utilized as infection prophylaxis, and applied as a liquid solution within the wound prior to closure.

Results

Ninety-five consecutive, non-instrumented, pediatric spinal surgeries were completed between 01/2015 and 12/2016, of which the last 68 utilized topical vancomycin. There was a 11.1% SSI rate in the non-topical vancomycin cohort versus 0% in the topical vancomycin cohort (P = 0.005). The number needed to treat was 9. There were no significant differences in risk factors for SSI between cohorts. There were no complications associated topical vancomycin use.

Conclusions

Routine topical vancomycin administration during closure of non-instrumented spinal procedures can be a safe and effective tool for reducing SSIs in the pediatric neurosurgical population.

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Author information

Author notes

  1. Samuel H. Cheshier and Gerald A. Grant are co-senior authors on this manuscript.

Authors and Affiliations

  1. Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA

    John G. D. Cannon, Allen L. Ho, Jyodi Mohole, Arjun V. Pendharkar, Eric S. Sussman, Samuel H. Cheshier & Gerald A. Grant

  2. Division of Neurosurgery, Lucile Packard Children’s Hospital Stanford, Palo Alto, CA, USA

    Samuel H. Cheshier & Gerald A. Grant

Authors
  1. John G. D. Cannon
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  2. Allen L. Ho
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  3. Jyodi Mohole
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  4. Arjun V. Pendharkar
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  5. Eric S. Sussman
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  6. Samuel H. Cheshier
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  7. Gerald A. Grant
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Corresponding author

Correspondence to Gerald A. Grant.

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Conflict of interest

The authors of this manuscript have no financial interest in the subject under discussion.

IRB approval

This work was approved by the Stanford IRB.

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Cannon, J.G.D., Ho, A.L., Mohole, J. et al. Topical vancomycin for surgical prophylaxis in non-instrumented pediatric spinal surgeries. Childs Nerv Syst 35, 107–111 (2019). https://doi.org/10.1007/s00381-018-3881-z

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  • DOI: https://doi.org/10.1007/s00381-018-3881-z

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