I’m having surgery later this week, and was told that somewhere before checking in and being rolled into the OR, I’m going to get IV vancomycin.
Have nosocomial infections become so common that patients are getting loaded up with antibiotics as soon as they walk in the door as a matter of routine? And no dithering around with sulfa, penicillin or even Cipro - just go right to some of the strongest stuff available. Perhaps it’s a regional issue, and there’s just a huge amount of MRSA walking around?
Or is the particular kind of surgery a factor in who gets vanco? Mine will be a laparoscopic microdiskectomy.
I haven’t heard anything about giving Vancomycin prophylactically, but I’m just a 2nd year student who is actually learning about Vancomycin right now. Until someone who might know more about it (like QTM) gets here, I’ll give an educated guess.
Since they are doing surgery on your spine, your immune system is very slow in fighting infections in cartilage because it isn’t well vasculated, so infections there can cause a lot of problems. They could be giving it to you to keep the cartilage in your spine from getting infected.
It seems to be common practice to give perioperative antibiotics to patients getting disc surgery, to prevent infection. Vancomycin is mentioned in the literature as being one of the agents used.
“Since the study by Horowitz and Curtin[4] published in 1975, prophylactic antibiotics have been the standard of care for patients undergoing lumbar disc surgery. With the use of perioperative antibiotics, the rate of infection has been reduced from greater than 9% to the current rate of less than 1% in patients undergoing lumbar diskectomy.”
Penicillin is the most widely used anti-biotic, or so I am told. Because I may be allergic to it, when I had endocarditis last year, I was put on vancomycin and ceftriaxone, which are both powerful anti-biotics. They did nothing to kill the nasties that had set up shop on my mitral valve. I was them put through a desensitization procedure for penicillin, which I was told would allow me to take penicillin for six weeks or so. I didn’t have a reaction during the procedure. My nasties died and I didn’t. My nasties were a fairly common mouth bacteria (rothia dentocariosa for those interested) that were highly susceptible to the penicillin/gentamycin combo I was put on. Towards the end of my anti-biotic course I broke out in hives
QFT. Reducing the post-op infection rate (a devastating complication, especially if it hits the spine) from 9% to 1% is quite the effective intervention.
And with the current explosion of Methicillin Resistant Staph Aureus popping up f**king everywhere, vancomycin certainly makes sense as the de facto standard of care. In my population, over 60% of staph infections are MRSA, and 90% of my skin infection patients have staph infections. And when staph goes past skin and into bone/nervous system/lung, etc, Vanco is the drug of choice.
Will it promote vancomycin resistance? Maybe. But given the evidence of how much harm it prevents, I’d not want to forego it for my back operation, based on theoretical concerns about future resistance.
There actually already is Vancomycin resistant microorganisms. There are some strains of Enterococcus and Staph aureus that is already resistant to it… Which of course is really bad for the future.
I didn’t think they were going to give me the stuff just for giggles, so there was bound to be a reason for it, and as I vaguely suspected, MRSA is the reason.
If I heard right, my surgeon has done this procedure about 6,000 times, so if he said I will have a better recovery if I wear red socks, I will buy red socks. 6,000 sounds high, but he has been in practice long enough to have written a few textbooks on neurosurgery.