Evaluating the Effectiveness of Vancomycin in Preventing Infections in Spinal Fixation Surgeries

Objective: This study aimed to evaluate the efficacy of topical vancomycin in preventing surgical site infections (SSI) following spinal fixation surgeries. Methodology: This retrospective cohort study was conducted at the Bangladesh Spine & Orthopaedic Hospital, Dhaka, Bangladesh. Participants were divided into two groups: treatment and control. In the treatment group, topical vancomycin powder was applied immediately after spinal surgery. Two-thirds of the powder was applied directly to the bones and muscles at the end of the surgery, while the remaining powder was applied between the fascia and fat layer after fascia closure. The vancomycin dose ranged from 0.5 to 2 grams, depending on wound size and surgery type; 75% of patients received 1 gram of vancomycin. Results: A total of 456 patients underwent spinal surgeries in this study. Among them, 81 patients were treated with vancomycin powder, and 375 were assigned to the control group. In total, 28 cases of SSIs were observed across both groups: 8 cases in the vancomycin group and 20 in the control group. The SSI incidence rate was higher in the treatment group (9.9%) compared to the control group (5.3%), with infections typically occurring within 14 days post-surgery. Of the reported SSIs, 43% were superficial, while 57% were classified as deep infections. Conclusion: In conclusion, this study did not find evidence supporting the efficacy of topical vancomycin powder in preventing SSIs following spinal fixation surgeries. However, no adverse effects were observed during the study period.