Efficacy of powdered vancomycin in the prophylaxis of surgical site infections in posterior thoracic and/or lumbar spine surgery: a systematic review of randomized clinical trials with meta-analysis.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2026;14(6):13 Neurosurg Rev. 2025 01-Nov:. 10.1007/s10143-025-03963-7What this means for my practice?
Topical powdered vancomycin applied to the surgical wound significantly reduces surgical site infections in posterior thoracic and lumbar spine surgery according to randomized controlled trial evidence. Clinically, this intervention may be a useful addition to standard antibiotic prophylaxis to prevent postoperative infection in spine surgery. Key limitations include a small number of RCTs, heterogeneity in surgical procedures and vancomycin dosing, and limited long-term safety data.
Study Summary
Five randomized controlled trials including 1677 patients undergoing posterior thoracic or lumbar spine surgery were included in this systematic review and meta-analysis comparing topical powdered vancomycin applied to the surgical wound versus standard surgical prophylaxis without vancomycin. Pooled outcomes of interest included incidence of surgical site infections (SSI) and evaluation of safety outcomes and microbiological profiles of infections. The pooled analysis demonstrated that powdered vancomycin significantly reduced surgical site infections, with 16 infections in the intervention group vs. 34 infections in the control group. Overall, the findings suggest that local application of vancomycin powder reduces SSI risk in thoracic and lumbar spine surgeries, although further research is needed to confirm long-term safety and broader applicability.
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