Intra-Operative Topical Vancomycin Powder Application-Is the Practise Safe in Paediatric Spine Surgeries?

Introdcution: Various methods have been developed and implemented to prevent SSI in the paediatric population. The practices vary among different groups of surgeons based on their training and expertise. One such practice is the application of Topical Vancomycin Powder (TVP) in the surgical wound before closure. Vancomycin powder is increasingly used off-label as TVP to prevent infection in spine surgeries. Uncertainty exists on its safety and usefulness in pediatric population. Hence, we aim to systematically review the available articles on TVP use in pediatric spine surgeries exploring the usefulness and safety of such practice. Materials and Methods: We conducted independent and duplicate electronic database search in PubMed, Embase and Cochrane Library till March 2020 to identify all relevant literature on the use of TVP for pediatric spine surgeries. Surgical Site Infection (SSI) rate, specific reported complications, reoperation rate, microbial flora pattern in reported SSI and safety profile were the outcomes analyzed. Analysis was performed in R platform using OpenMeta Analyst software. Results: No prospective studies were available to evaluate the use of TVP in pediatric spine surgeries for the prevention of SSIs. Neither standardized protocol nor drug dosage or safety profile was established for pediatric use. Three retrospective cohort studies including 824 patients (TVP/Control = 400/424) were included in the meta-analysis. There was a low-quality evidence suggesting no significant difference between the two groups in SSI rate (RR = .474, 95\% CI 0.106, 2.112,P=.327) with significant heterogeneity (I2 = 70.14, P = .035). TVP group showed a significant benefit on cost-analysis in one of the included studies. However, TVP did not prevent gram-negative coinfection on SSI in the TVP group. Conclusion: TVP does not qualify to be recommended as a safe and useful option to prevent SSI following pediatric spine surgeries from the literature available at present. High-quality prospective interventional studies are needed to arrive at a consensus on its use along with appropriate dosage and method of application.