Post-surgical site infections lead to significant morbidity and mortality, as well as significant healthcare costs. Despite intravenous prophylactic antibiotic measures, the rates of surgical site infections, especially those from skin pathogens, have been reported to be up to 15% in individuals undergoing spinal surgery. Thus, the use of vancomycin powder has gained significant popularity in the last few years [1,2]. With the use of topical vancomycin prophylaxis, such infections have decreased to 0.7% to 11.9% [3]..

In one recent study, the overall rate of surgical site infections was decreased from 6.3% to 0.9% in patients who had topical vancomycin used intraoperatively during instrumented spinal surgeries [4].

Not only did the study point to a significantly decreased risk of infection when intraoperative topical vancomycin powder was used, but there was also a shorter duration of infection as well. However, a significant percentage of wound infections in these post-surgical patients was due to the gram-negative organism Pseudomonas aeruginosa .

There are many advantages to using local topical administration of Vancomycin versus parenteral infusion. Parenteral infusion requires about an hour for infusion (prior to incision) to achieve effective systemic levels, which is not required with topical application.

Furthermore, antibiotic distribution is limited systemically secondary to decreased antibiotic bioavailability while with intravenous administration of vancomycin, there is an increased risk of adverse events such as nephrotoxicity, flushing, rash, and hypotension.