Evidence map›Paper›PMID 31863932›Full record

ArticleThe spine journal : official journal of the North American Spine Society2020

Progress not panacea: vancomycin powder efficacy and dose evaluated in an in vivo mouse model of spine implant infection.

Howard Y Park, Vishal Hegde, Stephen D Zoller, William Sheppard, Christopher Hamad, Ryan A Smith, Marina M Sprague, Joshua D Proal, John Hoang, Amanda Loftin and 5 more

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The spine journal : official journal of the North American Spine Society, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed, 1 pooled it
0.9field-weighted citation impact, top 24% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 1 synthesis or guideline pooled it, 12 citations in OpenAlex.

  1. Clinical outcomes and complications after biportal endoscopic spine surgery: a comprehensive systematic review and meta-analysis of 3673 cases.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2023
    Pooled it
  2. Article
  3. Surgeon reported practice patterns related to full endoscopic cervical decompression procedures.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2023
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors at 2 institutions in 1 country.

Howard Y ParkDepartment of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, CA, USA.
Vishal HegdeDepartment of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, CA, USA.
Stephen D ZollerDepartment of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, CA, USA.
William SheppardDepartment of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, CA, USA.
Christopher HamadDepartment of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, CA, USA.
Ryan A SmithDepartment of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, CA, USA.
Marina M SpragueDepartment of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, CA, USA.
Joshua D ProalDepartment of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, CA, USA.
John HoangDepartment of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, CA, USA.
Amanda LoftinDepartment of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, CA, USA.
Gideon BlumsteinDepartment of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, CA, USA.
Zachary BurkeDepartment of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, CA, USA.
Nicolas CevallosDepartment of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, CA, USA.
Anthony A ScadutoDepartment of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, CA, USA; Orthopaedic Institute for Children, Los Angeles, CA, USA.
Nicholas M BernthalDepartment of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, CA, USA; Orthopaedic Institute for Children, Los Angeles, CA, USA. Electronic address: nbernthal@mednet.ucla.edu.
University of California, Los Angeles · USOrthopaedic Institute for Children · US

Funding

Regenerative Musculoskeletal Medicine Training ProgramT32AR059033 · NIAMS · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI John S Adams, Nicholas M. Bernthal · 2011 to 2026
$4.8M
Modifying and Delivering Antimicrobials to Prevent Orthopaedic Implant InfectionsK08AR069112 · NIAMS · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI BERNTHAL, NICHOLAS M. · 2016 to 2019
$704k
NIAMS NIH HHS K08 AR069112NIAMS NIH HHS T32 AR059033
6 · The paper itself

Abstract

backgroundIntrawound vancomycin powder (VP) has been rapidly adopted in spine surgery with apparent benefit demonstrated in limited, retrospective studies. Randomized trials, basic science, and dose response studies are scarce. PURPOSE: This study aims to test the efficacy and dose effect of VP over an extended time course within a randomized, controlled in vivo animal experiment. STUDY DESIGN/

settingRandomized controlled experiment utilizing a mouse model of spine implant infection with treatment groups receiving vancomycin powder following bacterial inoculation.

methodsUtilizing a mouse model of spine implant infection with bioluminescent Staphylococcus aureus, 24 mice were randomized into 3 groups: 10 infected mice with VP treatment (+VP), 10 infected mice without VP treatment (No-VP), and 4 sterile controls (SC). Four milligrams of VP (mouse equivalent of 1 g in a human) were administered before wound closure. Bioluminescence imaging was performed over 5 weeks to quantify bacterial burden. Electron microscopy (EM), bacterial colonization assays (Live/Dead) staining, and colony forming units (CFU) analyses were completed. A second dosing experiment was completed with 34 mice randomized into 4 groups: control, 2 mg, 4 mg, and 8 mg groups.

resultsThe (+VP) treatment group exhibited significantly lower bacterial loads compared to the control (No-VP) group, (p<.001). CFU analysis at the conclusion of the experiment revealed 20% of mice in the +VP group and 67% of mice in the No-VP group had persistent infections, and the (+VP) treatment group had significantly less mean number of CFUs (p<.03). EM and Live/Dead staining revealed florid biofilm formation in the No-VP group. Bioluminescence was suppressed in all VP doses tested compared with sterile controls (p<.001). CFU analysis revealed a 40%, 10%, and 20% persistent infection rate in the 2 mg, 4 mg, and 8 mg dose groups, respectively. CFU counts across dosing groups were not statistically different (p=.56).

conclusionsVancomycin powder provided an overall infection prevention benefit but failed to eradicate infection in all mice. Furthermore, the dose when halved also demonstrated an overall protective benefit, albeit at a lower rate. CLINICAL SIGNIFICANCE: Vancomycin powder is efficacious but should not be viewed as a panacea for perioperative infection prevention. Dose alterations can be considered, especially in patients with kidney disease or at high risk for seroma.

Indexed as

AnimalsAnti-Bacterial AgentsMicePowdersRetrospective StudiesSurgical Wound InfectionVancomycinAnti-Bacterial AgentsPowdersVancomycinBiofilmInfectionSurgical site infectionVancomycin powder

Identifiers

PMID31863932
PMCPMC7351246
OpenAlexW2995233531

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.