الفهرس 
Anatomy of the Back
Prevention of Surgical Site InfectionsOnly 14 pages are availabe for public view
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Abstract
In spine procedures, the use of systemic antibiotics as surgical prophylaxis is already common. Despite this, surgical site infection remains a big issue in all surgeries. Because of these concerns, lyophilized vancomycin powder has been placed directly into the surgical wound during closure as a form of perioperative antibiotic prophylaxis in several investigations. The drug’s intra-site administration should reduce fast absorption into the systemic circulation, minimize vancomycin-related side effects and provide a corner stone to reduce SSIs. The study is to assess the role of application of local vancomycin in prevention of surgical site infection in spinal surgeries. We conducted a randomized trial study designed to evaluate the patients who underwent open spine surgery in the orthopedic department of Tanta University hospital. This study included 42 patients who underwent all type of instrumentation included anterior and posterior approaches and even without instrumentation as decompression surgery from April 2022 and October 2022. Patients were divided into two groups: using randomizing system as “treatment group” in which the vancomycin is applied deep to deep fascia and muscles and superficial at subcutaneous tissues and “control group” in which local antibiotic was not applied. According to the demographic data the treatment group there were 18 (86%) males and 3 (14%) females. In the placebo group there were 15 (71%) males and 6 (29%) females. The age was distributed as follow in which mean age was 52 years (Range from 24 to 70 years) in treatment group and 43 years (Range from 24 to 71 years) in the placebo group with statistical significant difference between groups (P value =0.08). AS regarding past medical history there were 4 (19%) DM in treatment group and 2 (10%) in the placebo group with statistical significant difference between groups (P value =0.01). As regarding smoking history there were 7 (33%) in the treatment group and 2 (10%) smokers in the placebo group with statistically significant difference between groups (P value =0.001). As regrading body mass index BMI the mean 26.4±1.02 kg/m2 in the treatment group and mean BMI is 27.2±1.2 kg/m2 in placebo group with no statistical significant difference between groups (P value =0.1). The mean operative time in both groups was nearly equal as it was 2.4±0.37 hrs in the treatment group and 2.4±0.44 in the placebo group without statistical significant differences between both groups which means that the operative time had no rule in the infection rate in our series The mean intraoperative blood loss was nearly equal as it was 190.47±54.7 in the treatment group and 195.2±46.04 ml in the placebo without statistical significant differences between both groups which means that the intraoperative blood loss had no rule in the infection rate in our series In the treatment group, most of the patients were cured by 86% their age ranged from 24 to 70 with mean age was 52 years old. In the placebo group, the patients were cured by 71% (lower than the treatment group) most of them ranged from 24 to 71 with mean age was 43 years. The infection was present in 14.28 % of the treatment group all of them were older in age than the cured group which means that the older the age the lesser cure rate. In the placebo group the infection presents in 28.57% of the patients their culture revealed multiple organisms than in the treatment group which means that the vancomycin had a rule in reducing the infection rate. Also, accidently we found the infectious organisms present in older patient age rather than younger which confirm that the older the age the more sustainability to infection. In our study the diabetic patients in the treatment group suffered from infection in 3 (14%) patients out of four all of them were superficial infection with E.coli in two patients and culture negative (CN) in the other one. while in the placebo group the whole diabetic patients 2 (10%) suffered from infection one of them was E.coli and the other one was positive for MRSA. Although there were no statistical significant differences between both groups the overall diabetic patents were susceptible to infection site more than the non-diabetic patients and the vancomycin antibiotic powder helps in reduce incidence of SSI over all. In our study the all-smoker patients in the treatment group were cured without infection 7 (33%). In the placebo group the whole smoker patients 2 (10%) were suffered from infection one of them was E.coli and the other was culture negative. On comparing the mean value of ESR level at follow-up time post operatively there was no any statistical significant differences in ESR level between both groups. However, there were observed reduction if ESR level especially in the treatment group with time. There was statistical significant differences in CRP level between both groups at 10 days, 2weeks, and 8 weeks. According to Southampton scale we found that, in the treatment group we found most of our cases 13 (62%) cases with grade developed category A, 7 cases (33%) in category B and only one with category C. In the placebo group, we found most of our cases 11 (52%) cases with category A. There were 6 (29%) cases in category B and the remaining 3 cases (14%) of category C.