---
title: "Intrawound Vancomycin and Surgical Site Infection After Posterior Spinal Fusion: STRIVE Trial Anal"
id: "pubmed-41902726"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-41902726"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/41902726/"
doi: "10.1097/BRS.0000000000005671"
published_at: "2026-09-15T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Intrawound Vancomycin and Surgical Site Infection After Posterior Spinal Fusion: STRIVE Trial Anal
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-41902726
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/41902726/)
- **DOI:** [10.1097/BRS.0000000000005671](https://doi.org/10.1097%2FBRS.0000000000005671)
- **Published At:** 2026-09-15T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Study design: retrospective analysis of prospectively collected data from the STRIVE trial assessing intrawound antibiotic use in posterior spinal fusion (PSF) surgery. The analysis focused on vancomycin powder used intraoperatively. - Objective: to re-evaluate whether **intrawound vancomycin** reduces postoperative **surgical site infection (SSI)** in PSF patients. - Population: 3,595 patients enrolled in STRIVE; 3,311 underwent surgery and were included in the analysis. - Exposure groups: 847 patients (26%) received only intrawound vancomycin; 1,534 patients (46%) received no intrawound antibiotics. - Primary outcome: postoperative SSI. Sixty patients (8% of those with SSI) developed postoperative infection overall; 20 of these (33%) had received intrawound vancomycin. - Main result: receipt of intrawound vancomycin was not associated with a statistically significant reduction in SSI compared with no intrawound antibiotics (OR 0.77; 95% CI 0.42–1.42). - Secondary outcomes: intrawound vancomycin was not associated with critical care stay (OR 0.94; 95% CI 0.78–1.12) or sepsis (OR 2.04; 95% CI 0.62–6.73). - Adverse associations: intrawound vancomycin use was associated with increased odds of hospital readmission (OR 1.82; 95% CI 1.28–2.6; P < 0.001) and reoperation (OR 1.75; 95% CI 1.18–2.6; P = 0.005). - Predictors of vancomycin use: intraoperative antibiotic readministration increased odds of vancomycin use (OR 2.97; 95% CI 1.36–6.5; P = 0.006). Geographic differences: lower odds of intrawound vancomycin use in Europe (OR 0.13; 95% CI 0.06–0.29) and Asia (OR 0.02; 95% CI 0–0.08) versus North America. - Conclusion: In this STRIVE trial dataset, intraoperative **vancomycin** powder was not associated with reduced **SSI** incidence after **PSF** surgery. Level of evidence: II. - Conflicts of interest disclosed for several authors; remaining authors reported no conflicts.
## Clinical Analysis & Structured Key Points
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Epub 2026 Feb 27. # Vancomycin Effectiveness in Reducing Surgical Site Infection in Posterior Spinal Fusion Surgery: A Retrospective Data Analysis of the STRIVE Trial [Aditya Joshi](https://pubmed.ncbi.nlm.nih.gov/?term=Joshi+A&cauthor_id=41902726)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41902726/#full-view-affiliation-1 "Department of Orthopaedic Surgery, Johns Hopkins University National Capital Region, Bethesda, MD."), [Ryan M Schiedo](https://pubmed.ncbi.nlm.nih.gov/?term=Schiedo+RM&cauthor_id=41902726), [Rachel S Bronheim](https://pubmed.ncbi.nlm.nih.gov/?term=Bronheim+RS&cauthor_id=41902726), [Jordan A Helbing](https://pubmed.ncbi.nlm.nih.gov/?term=A+Helbing+J&cauthor_id=41902726), [Amit Jain](https://pubmed.ncbi.nlm.nih.gov/?term=Jain+A&cauthor_id=41902726), [Khaled M Kebaish](https://pubmed.ncbi.nlm.nih.gov/?term=Kebaish+KM&cauthor_id=41902726), [Hamid Hassanzadeh](https://pubmed.ncbi.nlm.nih.gov/?term=Hassanzadeh+H&cauthor_id=41902726) Affiliations Expand ### Affiliation * 1 Department of Orthopaedic Surgery, Johns Hopkins University National Capital Region, Bethesda, MD. * PMID: **41902726** * DOI: [ 10.1097/BRS.0000000000005671 ](https://doi.org/10.1097/brs.0000000000005671) Item in Clipboard Randomized Controlled Trial # Vancomycin Effectiveness in Reducing Surgical Site Infection in Posterior Spinal Fusion Surgery: A Retrospective Data Analysis of the STRIVE Trial Aditya Joshi et al. Spine (Phila Pa 1976). 2026. Show details Display options Display options Format Abstract PubMed PMID Spine (Phila Pa 1976) Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Spine+%28Phila+Pa+1976%29%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Spine+%28Phila+Pa+1976%29%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/41902726/) . 2026 Sep 15;51(18):1280-1285. doi: 10.1097/BRS.0000000000005671. Epub 2026 Feb 27. ### Authors [Aditya Joshi](https://pubmed.ncbi.nlm.nih.gov/?term=Joshi+A&cauthor_id=41902726)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41902726/#short-view-affiliation-1 "Department of Orthopaedic Surgery, Johns Hopkins University National Capital Region, Bethesda, MD."), [Ryan M Schiedo](https://pubmed.ncbi.nlm.nih.gov/?term=Schiedo+RM&cauthor_id=41902726), [Rachel S Bronheim](https://pubmed.ncbi.nlm.nih.gov/?term=Bronheim+RS&cauthor_id=41902726), [Jordan A Helbing](https://pubmed.ncbi.nlm.nih.gov/?term=A+Helbing+J&cauthor_id=41902726), [Amit Jain](https://pubmed.ncbi.nlm.nih.gov/?term=Jain+A&cauthor_id=41902726), [Khaled M Kebaish](https://pubmed.ncbi.nlm.nih.gov/?term=Kebaish+KM&cauthor_id=41902726), [Hamid Hassanzadeh](https://pubmed.ncbi.nlm.nih.gov/?term=Hassanzadeh+H&cauthor_id=41902726) ### Affiliation * 1 Department of Orthopaedic Surgery, Johns Hopkins University National Capital Region, Bethesda, MD. * PMID: **41902726** * DOI: [ 10.1097/BRS.0000000000005671 ](https://doi.org/10.1097/brs.0000000000005671) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Study design:** Retrospective analysis of prospectively collected data. **Objective:** To re-evaluate vancomycin as a preventive measure for surgical site infection (SSI). **Summary of background data:** Intrawound vancomycin powder is used to prevent SSIs in spinal surgery. Prior studies, often limited to single institutions or small samples, have shown mixed efficacy and potential increases in non- S. aureus and Gram-negative infections. We hypothesized that SSIs rates would be similar with and without intrawound vancomycin in posterior spinal fusion (PSF) surgery. **Methods:** Prospectively collected data from the 3595 patients in the STaphylococcus aureus suRgical Inpatient Vaccine Efficacy (STRIVE) trial were stratified by intrawound antibiotic usage. Multivariate logistic regression assessed the effect of vancomycin use on SSI, adjusting for patient demographics and SSI-associated risk factors. Secondary outcomes included critical care stay, reoperation, sepsis, and hospital readmission. **Results:** Of 3311 patients who underwent surgery, 847 (26%) received only intrawound vancomycin and 1534 (46%) received no intrawound antibiotics. Sixty (8%) patients developed postoperative SSI, of whom 20 (33%) had received intrawound vancomycin. Receiving intrawound vancomycin was not associated with SSI incidence versus no intrawound antibiotics [odds ratio (OR): 0.77; 95% CI: 0.42-1.42], critical care stay (OR: 0.94; 95% CI: 0.78-1.12), or sepsis (OR: 2.04; 95% CI: 0.62-6.73). However, intrawound vancomycin was associated with increased odds of hospital readmission (OR: 1.82; 95% CI: 1.28-2.6; P < 0.001) and reoperation (OR: 1.75; 95% CI: 1.18-2.6; P = 0.005). Factors significantly associated with intrawound vancomycin use included intraoperative antibiotic readministration (OR: 2.97; 95% CI: 1.36-6.5; P =0.006) and hospital location, lower odds in Europe (OR: 0.13; 95% CI: 0.06-0.29; P < 0.001) or Asia (OR: 0.02; 95% CI: 0-0.08; P < 0.001) versus North America. **Conclusions:** Intraoperative vancomycin use was not associated with reduced SSI incidence compared with no intrawound antibiotics after PSF surgery. **Level of evidence:** Level II. **Keywords:** complications; fusion; intraoperative intrawound vancomycin; intrawound antibiotics; posterior spinal surgery; readmission; retrospective; surgical site infection; vancomycin; vancomycin powder. Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement A.J. is a paid consultant for DePuy, Globus Medical, and Stryker. K.K. receives royalties from DePuy, Stryker, and Orthofix; serves as a paid consultant and presenter/speaker for DePuy, Orthofix, and K2 Medical; receives research support from DePuy; and is a board or committee member of the Scoliosis Research Society. H.H. is a paid consultant/speaker and has stock/stock options for Globus Medical; and is a paid speaker/presenter and receives research support from Orthofix. The remaining authors report no conflicts of interest. ## Similar articles * [ Does intrawound vancomycin powder reduce surgical site infection after posterior instrumented spinal surgery? A propensity score-matched analysis. ](https://pubmed.ncbi.nlm.nih.gov/29705336/) Horii C, Yamazaki T, Oka H, Azuma S, Ogihara S, Okazaki R, Kawamura N, Takano Y, Morii J, Takeshita Y, Maruyama T, Yamakawa K, Murakami M, Oshima Y, Tanaka S.Horii C, et al.Spine J. 2018 Dec;18(12):2205-2212. doi: 10.1016/j.spinee.2018.04.015. Epub 2018 Apr 26.Spine J. 2018.PMID: 29705336 * [ Decreased rate of surgical site infection after spinal surgery with instrumentation using bundled approach including surveillance and intrawound vancomycin application. ](https://pubmed.ncbi.nlm.nih.gov/30142843/) Sono T, Fujibayashi S, Izeki M, Shimizu Y, Masamoto K, Morizane K, Otsuki B, Tanida S, Nagao M, Ichiyama S, Matsuda S.Sono T, et al.Medicine (Baltimore). 2018 Aug;97(34):e12010. doi: 10.1097/MD.0000000000012010.Medicine (Baltimore). 2018.PMID: 30142843Free PMC article. * [ Local intrawound vancomycin powder decreases the risk of surgical site infections in complex adult deformity reconstruction: a cost analysis. ](https://pubmed.ncbi.nlm.nih.gov/25077909/) Theologis AA, Demirkiran G, Callahan M, Pekmezci M, Ames C, Deviren V.Theologis AA, et al.Spine (Phila Pa 1976). 2014 Oct 15;39(22):1875-80. doi: 10.1097/BRS.0000000000000533.Spine (Phila Pa 1976). 2014.PMID: 25077909 * [ Selection pressures of vancomycin powder use in spine surgery: a meta-analysis. ](https://pubmed.ncbi.nlm.nih.gov/30660741/) Gande A, Rosinski A, Cunningham T, Bhatia N, Lee YP.Gande A, et al.Spine J. 2019 Jun;19(6):1076-1084. doi: 10.1016/j.spinee.2019.01.002. Epub 2019 Jan 17.Spine J. 2019.PMID: 30660741 * [ Does the Application of Topical Vancomycin Reduce Surgical Site Infections in Spine Surgery? A Meta-analysis of Randomized Controlled Trials. ](https://pubmed.ncbi.nlm.nih.gov/38996386/) Daher M, Nassar JE, McDonald CL, Diebo BG, Daniels AH.Daher M, et al.Clin Orthop Relat Res. 2024 Dec 1;482(12):2212-2219. doi: 10.1097/CORR.0000000000003179. Epub 2024 Jul 12.Clin Orthop Relat Res. 2024.PMID: 38996386Free PMC article. [ See all similar articles ](https://pubmed.ncbi.nlm.nih.gov/?linkname=pubmed_pubmed&from_uid=41902726) ## References 1. 1. Aleem IS, Tan LA, Nassr A, Riew KD. Surgical site infection prevention following spine surgery. Global Spine J. 2020;10(1 Suppl):92S–98S. 2. 1. Yao R, Zhou H, Choma TJ, Kwon BK, Street J. Surgical site infection in spine surgery: who is at risk? Global Spine J. 2018;8(4_suppl):5S–30S. 3. 1. Nasser R, Kosty JA, Shah S, Wang J, Cheng J. Risk factors and prevention of surgical site infections following spinal procedures. Global Spine J. 2018;8(4 Suppl):44S–48S. 4. 1. Atesok K, Papavassiliou E, Heffernan MJ, et al. Current strategies in prevention of postoperative infections in spine surgery. Global Spine J. 2020;10:183–194. 5. 1. Zhou J, Wang R, Huo X, Xiong W, Kang L, Xue Y. Incidence of surgical site infection after spine surgery: a systematic review and meta-analysis. Spine (Phila Pa 1976). 2020;45:208–216. 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