Commentary on: "Sterile Seroma Resulting from Multilevel XLIF Procedure as Possible Adverse Effect of Prophylactic Vancomycin Powder: A Case Report".

Postoperative surgical site infection (SSI) is the second most common health care – associated infection in the United States, second only to urinary tract infections, and resulting in an estimated 8,205 deaths in 2002 alone. 1 Furthermore, SSIs have been shown to result in a prolongation of hospital stay by 9.7 days and increase treatment cost by $20,842 per admission. 2 Assuch, signi fi cant attention has been focused on means of reducing SSIs and their associated morbidity and excess health care costs. Gram-positive microorganisms are the most common cause of SSI following spine surgery. 3 The use of prophylactic intrawound vancomycin powder has recently become a more common practice due to its ease of application, low cost, and ability to achieve high local con-centrations with low systemic levels. 4,5 A recent meta-analy-sis found that vancomycin powder was associated with a signi fi cant reduction in SSI (odds ratio: 0.19, 95% con fi dence interval: 0.09 – 0.38). 6 Furthermore, cost analyses on patients undergoing lumbar fusion procedures have demonstrated that the use of vancomycin powder was associated with a cost savings of $438,165 per 100 spinal fusions performed. 7 As with any new technology, medication, or technique, adverse events and/or sequelae will inevitably surface following generalized practice implementation. Well-described adverse drug reactions to systemic intravenous vancomycin use include red