A COMPARATIVE STUDY ON THE ROLE OF VANCOMYCIN IN INFECTION PREVENTION DURING SPINAL FIXATION SURGERIES: A SYSTEMATIC REVIEW

Abstract

Background: Surgical site infections (SSIs) remain among the most serious complications following spinal fixation surgeries, contributing to increased morbidity, prolonged hospitalization, repeated surgical interventions, and substantial healthcare costs. Implant-associated infections are particularly challenging due to biofilm formation and the predominance of Gram-positive organisms, especially Staphylococcus aureus and methicillin-resistant Staphylococcus aureus (MRSA). Vancomycin, a glycopeptide antibiotic with potent Gram-positive coverage, has gained attention as an adjunct prophylactic strategy, particularly in intrawound form.

Objective: To evaluate the efficacy and safety of systemic and intrawound vancomycin in preventing SSIs in spinal fixation and instrumentation surgeries.

Methods: A systematic search of PubMed, Scopus, Web of Science, and Google Scholar was conducted from database inception to the latest available year. Eligible studies included randomized controlled trials, cohort studies, and meta-analyses assessing vancomycin prophylaxis in spinal instrumentation. Primary outcomes included overall SSI rates, deep and superficial infections, and pathogen distribution. Secondary outcomes included adverse effects and subgroup analyses in trauma and high-risk populations. Data were narratively synthesized due to heterogeneity in study design and dosing protocols.

Results: Twenty-seven studies comprising more than 30,000 patients were included. Intrawound vancomycin (1–2 g) reduced SSI rates from 13–20% in control groups to 0–5% in treated cohorts in several randomized and retrospective studies. Large thoracolumbar fusion cohorts reported infection rates of 0.2% versus 2.6% with adjunctive vancomycin. Meta-analyses demonstrated pooled odds ratios approximating 0.31, indicating significant reduction in postoperative infections. Protective effects were most pronounced in trauma patients, individuals with diabetes or obesity, and institutions with high MRSA prevalence. Reported systemic toxicity was minimal, with no consistent increase in nephrotoxicity. Occasional sterile seromas were noted. Some studies observed a proportional rise in Gram-negative infections.

Conclusion: Intrawound vancomycin appeared to be an effective adjunct to standard systemic prophylaxis in high-risk spinal fixation surgeries, particularly against Gram-positive pathogens including MRSA. A selective, risk-based approach was supported, while further multicenter randomized trials with standardized protocols and long-term resistance monitoring remain essential.