Serum and local vancomycin concentrations following intrawound application in elective lumbar spinal fusion: A secondary pharmacokinetic analysis of the vancomycin arm of a prospective randomized controlled trial
In brief
Intrawound vancomycin reaches ~1000 µg/mL locally with almost no serum exposure
In 140 patients undergoing elective lumbar fusion, a single gram of intrawound vancomycin produced wound-drain concentrations around 1,000 µg/mL-well above the MRSA MIC-while serum levels remained negligible (average 0.1 µg/mL, detectable in only 7% of patients). These data support its use as a safe adjunct to systemic antibiotics, though clinical infection outcomes were not assessed.
- Journal
- North American Spine Society journal (Q1)
- Published
- 15 July 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Lukas Florian Panzenböck, George Abdel Nour, Damian Leo Dürrschnabel, Matthias Pallamar, Petra Krepler
- PMID
- 42602394
- DOI
- 10.1016/j.xnsj.2026.100933
Why clinicians should know about it
- Picked for Pharmacology (medical) (paper of the day, 18 August 2026): Intrawound vancomycin PK analysis in spine surgery
- Picked for Surgery (top studies of the week, 16 August 2026): High-quality evidence in a top journal
Abstract
BACKGROUND: Intrawound vancomycin powder is widely used as an adjunct to systemic prophylaxis in spine surgery, yet prospective pharmacokinetic data are limited and concerns about systemic absorption persist. We report the prespecified pharmacokinetic endpoints of a randomized controlled trial, quantifying serum and local wound-drain vancomycin concentrations after intrawound application. METHODS: This is a secondary pharmacokinetic analysis of the vancomycin arm of a prospective, patient-blinded, randomized controlled trial. The 140 patients in this arm underwent elective 1- or 2-level posterior lumbar interbody fusion (August 2015-April 2019) and received 1 g intrawound vancomycin powder additional to routine i.v. cefuroxime prophylaxis. Serum vancomycin was measured on postoperative days 1, 2, 3, and 5 and wound-drain concentrations at 24 and 48 hours. RESULTS: Serum vancomycin was available for 106 to 110 of 140 patients on days 1 to 2 and remained negligible (day 1: 0.10 ± 0.48 µg/mL; day 5: 0.00 µg/mL); it was detectable in 7 of 106 patients (6.6%) on day 1, and no value exceeded 4.20 µg/mL. Wound-drain concentrations (104-105 of 140 patients) were supratherapeutic (day 1: 969.33 ± 798.08 µg/mL; day 2: 709.01 ± 470.23 µg/mL), with 100% of samples above the MRSA MIC₉₀ (2 µg/mL). CONCLUSIONS: In elective lumbar fusion, 1 g intrawound vancomycin produced supratherapeutic local wound-fluid concentrations with negligible systemic absorption, supporting its rationale as an adjunct to systemic prophylaxis.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.