Impacto do uso da vancomicina intraoperatória na taxa de infecção de cirurgia de coluna: revisão sistemática com metanálise

Abstract

Surgical site infections (SSIs) in spinal procedures are significant complications, with an incidence of up to 12%, increasing morbidity, length of hospital stay, and healthcare costs. Topical vancomycin has been used as prophylaxis against resistant microorganisms, particularly methicillin-resistant Staphylococcus aureus (MRSA). However, its clinical efficacy remains controversial. A systematic review with meta-analysis was conducted according to PRISMA and QUORUM guidelines, including studies published up to July 2024 in databases such as PubMed, Embase, Scielo, Cochrane, among others. Eight studies were selected, involving patients undergoing spinal surgery, comparing intraoperative use of powdered vancomycin with a control group. A total of 3,004 patients were analyzed (1,336 with vancomycin and 1,668 without). The standardized mean difference (SMD) was 0.51 [95% CI: -0.35 to 1.37], suggesting a trend toward clinical benefit without statistical significance. Heterogeneity was high (I² = 98%), reflecting methodological variability among studies. Some individual studies showed benefit, while others observed no effect or reported potential harms. Despite some promising results, the intraoperative use of topical vancomycin for SSI prevention in spinal surgeries has not been statistically proven effective. Given the heterogeneity and limitations of current evidence, more robust and standardized clinical trials are needed to establish definitive guidelines.