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DeFrancesco CJ, Flynn JM, Smith JT, et al. Clinically apparent adverse reactions to intra-wound vancomycin powder in early onset scoliosis are rare. J Child Orthop. 2017;11(6):414-418doi: 10.1302/1863-2548.11.170107.
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. (2017). Clinically apparent adverse reactions to intra-wound vancomycin powder in early onset scoliosis are rare. Journal of children's orthopaedics, 11(6), 414-418. https://doi.org/10.1302/1863-2548.11.170107
DeFrancesco, C J, et al. "Clinically apparent adverse reactions to intra-wound vancomycin powder in early onset scoliosis are rare." Journal of children's orthopaedics vol. 11,6 (2017): 414-418. doi: https://doi.org/10.1302/1863-2548.11.170107
DeFrancesco CJ, Flynn JM, Smith JT, Luhmann SJ, Sawyer JR, Glotzbecker M, Pahys J, Garg S, Vitale M, Farrington DM, Sturm P. Clinically apparent adverse reactions to intra-wound vancomycin powder in early onset scoliosis are rare. J Child Orthop. 2017 Dec 01;11(6):414-418. doi: 10.1302/1863-2548.11.170107. PMID: 29263752; PMCID: PMC5725766.
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J Child Orthop. 2017 Dec 01;11(6):414-418. doi: 10.1302/1863-2548.11.170107.

Clinically apparent adverse reactions to intra-wound vancomycin powder in early onset scoliosis are rare.

Journal of children's orthopaedics

C J DeFrancesco, J M Flynn, J T Smith, S J Luhmann, J R Sawyer, M Glotzbecker, J Pahys, S Garg, M Vitale, D M Farrington, P Sturm,

Affiliations

  1. The Children's Hospital of Philadelphia, Division of Orthopaedics, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA and The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA.
  2. The Children's Hospital of Philadelphia, Division of Orthopaedics, Philadelphia, PA, USA, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA.
  3. Primary Children's Hospital, 100 Mario Capecchi Dr, Salt Lake City, UT 84113, USA.
  4. The St. Louis Children's Hospital, 1 Childrens Pl, St. Louis, MO 63110, USA.
  5. Le Bonheur Children's Hospital, 848 Adams Ave, Memphis, TN 38103, USA.
  6. Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA.
  7. Shriners Hospital for Children, Philadelphia, PA, USA and 3551 N Broad St, Philadelphia, PA 19140, USA.
  8. Children's Hospital of Colorado, 13123 E 16th Ave, Aurora, CO 80045, USA.
  9. Morgan Stanley Children's Hospital, 3959 Broadway Ave, New York, NY 10032, USA.
  10. Virgen del Rocio University Hospital, Spain and Av. Manuel Siurot, S/N, 41013 Sevilla, Spain.
  11. Cincinnati Children's Hospital, 3333 Burnet Ave, Cincinnati, OH 45229, USA.

PMID: 29263752 PMCID: PMC5725766 DOI: 10.1302/1863-2548.11.170107

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.

Keywords: Vancomycin powder; pharmacological adverse event; scoliosis; surgical site infection

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