Assessing the Role of Topical Vancomycin in Reducing Surgical Site Infections Following Spinal Surgery: A Comprehensive Review.

Surgical site infections (SSIs) are a potential complication that can occur after spinal surgery and significantly impact patients' well-being and healthcare systems. Topical vancomycin has become an attractive low-cost intervention to prevent SSIs in spinal surgery. However, in current literature, the efficacy of topical vancomycin in preventing SSIs is a well-debated topic with conflicting views. The primary objective of this review was to analyze relevant studies to evaluate whether vancomycin powder is an effective intervention in preventing SSIs following spinal surgery. A widespread electronic literature search was performed using three primary databases: Medline, Embase, and Web of Science. Relevant studies were screened using pre-defined inclusion and exclusion criteria focusing on outcomes of postoperative SSI incidence rates. Eligible articles should have set control groups of patients receiving only standard systemic antibiotics and treatment groups receiving topical vancomycin plus systemic prophylaxis. Data were extracted from included studies, and quality assessment was done, including the risk of bias. After full-text evaluation, 12 studies were included in this review, with a total of 9,224 patients. Three were randomized controlled trials (RCTs), two were prospective cohort, and seven were retrospective cohort studies. A total of 279 patients developed SSIs, with 194 SSIs in the control groups. Five studies demonstrated a statistically significant decrease in SSI rates with the application of vancomycin powder. Three studies showed a statistically insignificant reduction in SSI rates between vancomycin and control groups, but one presented a statistically significant decrease after propensity score matching of patients. The final four studies showed no statistically significant difference in SSI rates between both study arms. Therefore, seven studies supported the beneficial use of vancomycin powder in preventing SSIs following spinal surgery, while the other five studies had opposing views. Risk of bias was common throughout the studies, including confounding factors, selection and performance biases, and bias due to incomplete data. Overall, these findings signify the necessity of further well-designed RCTs with double blinding to confirm the effectiveness of topical vancomycin in preventing SSIs during spinal surgery. Clinicians may consider the application of vancomycin powder with caution and on a case-to-case basis.