The purpose of the study was to evaluate the effect of local application of vancomycin powder (VP) to prevent surgical site infections (SSIs) after posterior spine surgery. A comprehensive search of Web of Science, EMBASE, Pubmed, Ovid, and Cochrane Library databases for articles published was performed to collect comparative studies of intrawound vancomycin in posterior spine surgery before March 2021. Two reviewers independently screened eligible articles based on the inclusion and exclusion criteria, assessed the study quality, and extracted the data. Revman 5.4 software was used for data analysis. A total of 22 articles encompassing 11 555 surgical patients were finally identified for meta-analysis. According to the information provided by the included literature, the combined odds ratio showed that topical use of VP was effective for reducing the incidence of SSIs (P< 0.00001) after posterior spine surgery without affecting its efficacy in the treatment of deep infections (P< 0.00001). However, there is no statistical significance in superficial infections. In a subgroup analysis, VP at a dose of 1, 2, and 0.5-2 g reduced the incidence of spinal SSIs. The result of another subgroup analysis suggested that local application of VP could significantly reduce the risk of SSIs, whether it was administered after posterior cervical surgery or thoracolumbar surgery. Moreover, the percentage of SSIs due to gram-positive germs (P< 0.00001) and MRSA (P< 0.0001) could reduce after intraoperative VP was used, but did not significantly reduce to gram-negative germs. The local application of VP appears to protect against SSIs, gram-positive germs, and MRSA (methicillin-resistant Staphylococcus aureus) infections after the posterior spinal operation.

中文翻译：

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术中万古霉素粉末减少后脊柱手术后手术部位感染：系统评价和荟萃分析。


该研究的目的是评估局部应用万古霉素粉末（VP）预防脊柱后路手术后手术部位感染（SSI）的效果。全面检索 Web of Science、EMBASE、Pubmed、Ovid 和 Cochrane Library 数据库中已发表的文章，收集 2021 年 3 月之前脊柱后路手术中伤口内万古霉素的比较研究。两位审稿人根据纳入和排除独立筛选符合条件的文章标准、评估研究质量并提取数据。 Revman 5.4软件用于数据分析。最终确定了涉及 11 555 名手术患者的 22 篇文章进行荟萃分析。根据纳入文献提供的信息，综合优势比显示，局部使用VP可有效降低脊柱后路手术后SSIs的发生率（P<0.00001），且不影响其治疗深部感染的疗效（P< 0.00001）。然而，浅表感染没有统计学意义。在亚组分析中，1、2 和 0.5-2 g 剂量的 VP 可降低脊柱 SSI 的发生率。另一项亚组分析结果表明，局部应用 VP 可以显着降低 SSI 风险，无论是在颈椎后路手术还是胸腰椎手术后给药。此外，术中使用VP后，革兰氏阳性菌（P<0.00001）和MRSA（P<0.0001）引起的SSI百分比可以降低，但革兰氏阴性菌没有显着降低。局部应用 VP 似乎可以预防脊柱后路手术后的 SSI、革兰氏阳性菌和 MRSA（耐甲氧西林金黄色葡萄球菌）感染。