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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EDeep surgical site infection rates up to 15% have been reported after multilevel spinal surgery. Furthermore, there is an increasing incidence of cephalosporin-resistant bacterial strains. Interest in intrawound vancomycin powder has grown, with early data suggesting decreased infection rates, however, further research is needed in order to determine the dose with minimal detrimental effects on bone healing. This article reports on data from an in vitro study entitled Does Intrawound Application of Vancomycin Influence Bone Regeneration in Spinal Fusion?.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedic Procedures\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ESpine Conditions\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInfections\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedics Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedic Procedures\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ESpine Conditions\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInfections\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedics Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedics\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EDeep surgical site infection rates up to 15% have been reported after multilevel spinal surgery [Caroom C et al. \u003Cem\u003ESpine (Phila Pa 1976)\u003C\/em\u003E. 2013]. Furthermore, there is an increasing incidence of cephalosporin-resistant bacterial strains [Sweet FA et al. \u003Cem\u003ESpine (Phila Pa 1976)\u003C\/em\u003E. 2011]. Interest in intrawound vancomycin powder has grown, with early data suggesting decreased infection rates [Pahys JM et al. \u003Cem\u003EJ Bone Joint Surg Am.\u003C\/em\u003E 2013]. In a prior study, however, drainage from wounds treated with vancomycin was found to contain levels of vancomycin high enough to cause toxic effects in the surrounding tissue [Sweet F et al. \u003Cem\u003ESpine J.\u003C\/em\u003E 2009]. Thus, further research is needed in order to determine the vancomycin dose for intrawound application that optimizes bactericidal effects while minimizing detrimental effects on bone healing.\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EMichael Ogon, MD, PhD, Orthopaedic Hospital Speising, Wien, Austria, reported data from an in vitro study entitled Does Intrawound Application of Vancomycin Influence Bone Regeneration in Spinal Fusion? [Eder C et al. \u003Cem\u003ESpine\u003C\/em\u003E. 2014], indicating that locally applied vancomycin interferes with migration, proliferation, and differentiation of human osteoblasts (particularly at doses of 6 and 12 mg\/cm\u003Csup\u003E2\u003C\/sup\u003E) and thus may influence bone fusion after spinal surgery.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EThe protocol for this study was based on a phase 1 US Dose Escalation Trial of Intrasite Vancomycin Pharmacokinetics study [\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01764750\u0026amp;atom=%2Fspmdc%2F14%2F50%2F10.atom\u0022\u003ENCT01764750\u003C\/a\u003E], which was designed to develop rules for standardizing application and dosing, define peak\/trough concentrations and clearance parameters, verify bactericidal potency, and select a dose for use in future studies. The study is not yet open for recruitment but expects to enroll 40 adult patients who are undergoing posterior instrumented spinal surgery with an instrumented fusion of \u2265 3 vertebral levels. The primary outcome measures were wound and seroma vancomycin concentrations.\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EThe objectives of this study [Eder C et al. \u003Cem\u003ESpine\u003C\/em\u003E. 2014] were to assess the effect of vancomycin on changes in local pH, cell migration, proliferation, viability, and morphological changes. Prof Ogon presented data based on an analysis of bone samples from 10 patients (5 men and 5 women; mean age 57 years; 2 smokers). Cells were cultured in Dulbecco\u0027s modified Eagle\u0027s medium plus 10% fetal calf serum plus 2 mM L-glutamine plus 0.05 ascorbic acid plus gentamycin 50 \u03bcg\/ml plus vancomycin 3, 6, or 12 mg\/cm\u003Csup\u003E2\u003C\/sup\u003E or no vancomycin.\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003ELocal application of vancomycin was associated with a significant decline in pH to a nonphysiologic range at doses of 6 mg\/cm\u003Csup\u003E2\u003C\/sup\u003E (\u003Cem\u003EP\u003C\/em\u003E \u0026lt; .015) or 12 mg\/cm\u003Csup\u003E2\u003C\/sup\u003E (\u003Cem\u003EP\u003C\/em\u003E \u0026lt; .001). It also resulted in a dose-dependent suppression of osteoblast migration (control, 100%; 3 mg\/cm\u003Csup\u003E2\u003C\/sup\u003E, 44%; 6 mg\/cm\u003Csup\u003E2\u003C\/sup\u003E, 33%).\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EAfter 24 hours, cell proliferation and viability were also reduced, with the reductions being significant at the 6 and 12 mg\/cm\u003Csup\u003E2\u003C\/sup\u003E doses for proliferation and at the 12 mg\/cm\u003Csup\u003E2\u003C\/sup\u003E dose for viability (both \u003Cem\u003EP\u003C\/em\u003E \u0026lt; .001). The application of vancomycin also led to a significant (\u003Cem\u003EP\u003C\/em\u003E \u0026lt; .001) inhibition of alkaline phosphatase expression (15.4% in controls vs 1.8% at 3 mg\/cm\u003Csup\u003E2\u003C\/sup\u003E and undetectable at the 6 and 12 mg\/cm\u003Csup\u003E2\u003C\/sup\u003E doses).\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EDr Ogon concluded that cell migration, proliferation, and differentiation are key factors in osteogenesis. To properly balance the risks of infection and nonunion, controlled in vivo studies should be conducted to establish the minimal local concentrations of vancomycin necessary for infection prevention.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/50\/10.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzlt21\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}