THE ROLE OF TOPICAL VANCOMYCIN IN REDUCING SURGICAL SITE INFECTION AFTER TRANSPEDICULAR FIXATION IN PATIENTS WITH OBESITY

Background. Patients with obesity are at a high risk of developing surgical site infection after spinal surgery due to inadequate concentrations of systemic antibiotics in adipose tissue and technical difficulties of the procedure.

Aim. To evaluate the role of local application of vancomycin powder in reducing the incidence of surgical site infection during transpedicular fixation in patients with obesity.

Materials and methods. A prospective controlled non-randomized study in two sequential cohorts was conducted. The study included 112 patients with body mass index over 35 kg/m² who underwent elective transpedicular fixation of the lumbar spine. The control group (n=56) received standard prophylaxis (intravenous cefazolin 2 g). The intervention group (n=56) additionally received 1 g of vancomycin powder topically during surgery. The primary endpoint was the incidence of deep surgical site infection within 180 days.

Results. The incidence of deep surgical site infection was 25.0 % (14/56) in the control group and 14.3 % (8/56) in the vancomycin group (odds ratio 0.50; 95 % confidence interval: 0.19–1.30, p=0.15). Topical vancomycin significantly reduced the incidence of early (within 30 days) deep infections from 17.9 % to 5.4 % (p=0.04). The rate of superficial surgical site infection did not differ between groups (12.5 % vs. 8.9 %, p=0.54). No statistically significant increase in acute kidney injury (1.8 % vs. 3.6 %, p=0.56) or clinically significant seromas (1.8 % vs. 3.6 %, p=0.61) was observed. Vancomycin resistance was detected in 25 % of pathogens causing deep surgical site infection in the intervention group.

Conclusion. Topical application of vancomycin powder during transpedicular fixation in patients with obesity is a safe method that significantly reduces the incidence of early deep surgical site infection. Large randomized trials are needed for definitive recommendations.

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