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Impact of implant metal type and vancomycin prophylaxis on postoperative spine infection: an in-vivo study 

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Abstract

Purpose

To evaluate the effectiveness of vancomycin prophylaxis on spinal implant metal types.

Methods

42 rabbits underwent posterior, single-level instrumentation at L5-L6 with stainless steel (n = 18), cobalt chrome (n = 12), or titanium (n = 12) wire. All implants were inoculated with 1 × 106 colony forming units (CFU) of methicillin-resistant S. Aureus (MRSA). In the intrawound vancomycin subgroup (n = 18, 6 from each metal type), 40 mg of vancomycin powder was placed in the wound. In the IV vancomycin subgroup (n = 6, all stainless steel), 15 mg/kg of IV vancomycin was given preoperatively. Local soft tissue and implants were harvested 1-week postoperatively and separately cultured.

Results

Intrawound vancomycin significantly reduced the rate of soft tissue infection (44.4% vs 100%) and implant infection (27.8% vs 100%) (p < 0.001). Within the intrawound vancomycin subgroup, cobalt chrome implants were associated with higher median soft tissue MRSA growth (130 CFU) than stainless steel (0 CFU) or titanium (0 CFU) (p = 0.02). Cobalt chrome implants were also more likely to develop soft tissue MRSA infection (83.3%) as compared to stainless steel (16.7%) or titanium (33.3%) (p = 0.04). Median soft tissue MRSA growth among stainless steel implants without prophylaxis, with IV vancomycin, and with vancomycin powder was 1.18 × 107, 195, and 0 CFU, respectively. The rate of soft tissue MRSA infection without prophylaxis, with IV vancomycin, and with vancomycin powder was 100, 66.7, and 16.7%, respectively (p = 0.015).

Conclusion

Intrawound vancomycin is more effective than IV vancomycin and effectively reduces the risk of infection, but is less effective in cobalt chrome implants due to residual soft tissue infection.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Funding

NIH Grant for Statistical Analysis UL1 TR000002 received by Blythe Durbin-Johnson. Munish Gupta–DePuy Synthes (Royalty, consulting, education), Medical Device Business Services (Consulting), Medtronic (Consulting), Globus (Consulting), Alphatec Spine (Consulting).

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of California Davis, Sacramento, CA, USA

    Sukanta Maitra, Kavita Gupta, Pumibal Wetpiriyakul, Maria Pereira & Blythe Durbin-Johnson

  2. Department of Orthopaedic Surgery, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, USA

    Sachin Gupta & Ali S. Farooqi

  3. Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA

    Munish C. Gupta

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  1. Sachin Gupta
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Correspondence to Sachin Gupta.

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IRB approval received from the University of California IACUC (Institutional Animal Care and Use Committee).

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Gupta, S., Maitra, S., Farooqi, A.S. et al. Impact of implant metal type and vancomycin prophylaxis on postoperative spine infection: an in-vivo study . Spine Deform 11, 815–823 (2023). https://doi.org/10.1007/s43390-023-00674-1

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