The use of antibiotic-impregnated fibrin sealant for the prevention of surgical site infection associated with spinal instrumentation

Abstract

Purpose: The purpose of this study was to determine if the use of antibiotic-impregnated fibrin sealant (AFS) was effective in preventing surgical site infections (SSI) associated with spinal instrumentation.

Methods: In a preliminary study, five pieces of vancomycin-impregnated fibrin sealant, five nuts that were not treated with the sealant, and five nuts that were treated with the sealant were subjected to agar diffusion testing. In a clinical study, the rates of deep SSI were compared between 188 patients who underwent procedures involving spinal instrumentation without AFS (group 1) and 196 patients who underwent procedures involving spinal instrumentation with AFS (group 2).

Results: All five pieces of vancomycin-impregnated fibrin sealant and the five nuts treated with the sealant exhibited antimicrobial efficacy, while the five untreated nuts did not exhibit antimicrobial efficacy in the agar diffusion test. In the clinical study, 11 (5.8 %) of the 188 patients in group 1 acquired a deep SSI, while none (0 %) of the 196 patients in group 2 acquired a deep SSI.

Conclusion: The present study demonstrated that the application of AFS to spinal instrumentation yielded good clinical outcomes in terms of the prevention of postoperative spinal infections. It is hoped that limiting AFS use to patients requiring spinal instrumentation and those with risk factors for SSI will reduce the overall costs while preventing SSIs.

Fig. 1

a Photograph showing the surgical field with vancomycin sprinkled onto the fibrin layer. b Photograph showing the surgical field covered with an additional fibrin layer, which resulted in the application of vancomycin-impregnated fibrin sealant

Fig. 2

a Photograph showing the presence of an inhibition zone around a piece of vancomycin-impregnated fibrin glue sealant. b Photograph showing the absence of an inhibition zone around a nut that was not treated with vancomycin-impregnated fibrin glue sealant. c Photograph showing the presence of a clear inhibition zone around a nut that was treated with vancomycin-impregnated fibrin glue sealant

Fig. 3

Photographs showing the presence of clear inhibition zones around a representative sample at a 1 week, b 2 weeks, c 3 weeks, and d 4 weeks after the placement of a piece of vancomycin-impregnated fibrin glue sealant onto a Mueller–Hinton agar plate that was inoculated with methicillin-resistant Staphylococcus aureus (MRSA)