1. Clinically apparent adverse reactions to intra-wound vancomycin powder in early onset scoliosis are rare
- Author
-
DeFrancesco, C. J., Flynn, J. M., Smith, J. T., Luhmann, S. J., Sawyer, J. R., Glotzbecker, M., Pahys, J., Garg, S., Vitale, M., Farrington, D. M., Sturm, P., Children's Spine Study Grp, [DeFrancesco, C. J.] Childrens Hosp Philadelphia, Div Orthopaed, 3401 Civ Ctr Blvd, Philadelphia, PA 19104 USA, [Flynn, J. M.] Childrens Hosp Philadelphia, Div Orthopaed, 3401 Civ Ctr Blvd, Philadelphia, PA 19104 USA, [DeFrancesco, C. J.] Univ Penn, Perelman Sch Med, 3400 Civ Ctr Blvd, Philadelphia, PA 19104 USA, [Smith, J. T.] Primary Childrens Med Ctr, 100 Mario Capecchi Dr, Salt Lake City, UT 84113 USA, [Luhmann, S. J.] St Louis Childrens Hosp, 1 Childrens Pl, St Louis, MO 63110 USA, [Sawyer, J. R.] Le Bonheur Childrens Hosp, 848 Adams Ave, Memphis, TN 38103 USA, [Glotzbecker, M.] Boston Childrens Hosp, 300 Longwood Ave, Boston, MA 02115 USA, [Pahys, J.] Shriners Hosp Children, Philadelphia, PA USA, [Pahys, J.] 3551 N Broad St, Philadelphia, PA 19140 USA, [Garg, S.] Childrens Hosp Colorado, 13123 E 16th Ave, Aurora, CO 80045 USA, [Vitale, M.] Morgan Stanley Childrens Hosp, 3959 Broadway Ave, New York, NY 10032 USA, [Farrington, D. M.] Virgen del Rocio Univ Hosp, Seville, Spain, [Farrington, D. M.] Av Manuel Siurot S-N, Seville 41013, Spain, and [Sturm, P.] Cincinnati Childrens Hosp, 3333 Burnet Ave, Cincinnati, OH 45229 USA
- Subjects
medicine.medical_specialty ,Spinal deformity surgery ,Scoliosis ,pharmacological adverse event ,03 medical and health sciences ,0302 clinical medicine ,Vancomycin powder ,Ototoxicity ,medicine ,Orthopedics and Sports Medicine ,Dosing ,Adverse effect ,scoliosis ,030222 orthopedics ,Proteinuria ,business.industry ,Retrospective cohort study ,Metaanalysis ,surgical site infection ,medicine.disease ,Rash ,Surgery ,Anesthesia ,Pediatrics, Perinatology and Child Health ,Vancomycin ,Surgical site infections ,medicine.symptom ,Original Clinical Articles ,business ,030217 neurology & neurosurgery ,medicine.drug - Abstract
Purpose Spine surgeons have increasingly used intraoperative application of topical vancomycin powder (TVP) to prevent surgical site infections (SSIs). The goals of this study were to define the rate of pharmacological adverse reaction to TVP in young patients undergoing posterior spinal surgery and to summarise institutional variation in TVP dosing. Methods This retrospective observational study included ten spine centres in the United States and one in Europe. Patients with early onset scoliosis who underwent posterior spine surgery were eligible for inclusion. Age, weight, TVP dose and surgery type were recorded. Surgeries where patient age was > 12 years were excluded. Pharmacological adverse reactions were defined as clinical instances of Red Man Syndrome, rash, nephrotoxicity, proteinuria, hepatotoxicity or ototoxicity. The rate of pharmacological adverse reaction to TVP was calculated. Dosing practices were summarised. Results Patient age was in the range of seven months to 12 years (median ten years). Of 1398 observations, there was one possible pharmacological adverse reaction. This was in a ten-year-old, 20.4-kg female patient with neuromuscular sco-liosis undergoing growing rod implantation. She was dosed with 1500 mg of TVP and immediately developed a transient rash without systemic symptoms. This abated over minutes without any medical intervention. There were no other adverse reactions in the sample. The population rate of pharmacological adverse reaction was 0.072% (95% confidence interval 0 to 0.4). Significant variability in dosing practices existed between centres. Conclusion Pharmacological adverse reactions to TVP are rare. Future work may establish evidence-based guidelines for TVP dosing based on patient weight and other variables.
- Published
- 2017
- Full Text
- View/download PDF