Local vancomycin administration in Orthopaedic Surgery - A systematic review of comparative studies
Darius L. Lameire, Jack Soeder, Hassaan Abdel Khalik, Ellie Pinsker, Nipun Atri, Amir Khoshbin, Lenny Radomski, Amit Atrey
Abstract
; There is still controversy surrounding the routine use of vancomycin locally in primary orthopaedic surgery procedures. Therefore, the aim of this review is to assess how local vancomycin impacts the rates and microbiology of surgical site infections. ; A systematic electronic search of MEDLINE, EMBASE, and Web of Science was carried out for all comparative studies comparing locally applied vancomycin to control for primary orthopaedic surgery procedures published before August 14, 2022. ; A total of 61 studies with 65,671 patients were included for analysis. Forty-six studies used vancomycin powder, 12 studies with grafts soaked in vancomycin, two studies used vancomycin irrigation, and one study administered vancomycin interosseously. There were 15 studies (of 26) in spine surgery, five (of 14) in arthroplasty, ten (of 11) in sports medicine, and two (of five) in trauma surgery that found statistically significant decreases in overall infection rates when applying local vancomycin. Only one study (in spine surgery) found significant increases in infection rates with local vancomycin application. For spine surgery, local vancomycin application had greatest proportions of gram-negative bacteria (40.7 %) isolated compared to S. aureus (42.4 %) in controls. In arthroplasty and trauma surgery, there were increases in the proportions of gram-negative bacteria when vancomycin was added. There were no reported systemic adverse reactions associated with local vancomycin use in any of the studies. ; Applying local vancomycin during primary orthopaedic surgery procedures may reduce the rates of infections in multiple different orthopaedic specialties, particularly in sports medicine. However, given heterogeneity of included studies and breadth of surgical procedures included in this review, caution should be used when applying these findings to specific procedures. Level III. A systematic review of level I – III studies.