Vancomycin added to the wash solution of the cell-saver. Effect on bacterial contamination

Abstract

Objectives: The aim of this study is to test whether the addition of a low-dose of antibiotic (vancomycin) to the wash solution (saline) of the cell-saver reduces the incidence of bacterial contamination of the autologous red blood cell (RBCs) concentrate recovered.

Material and method: Experimental, randomized, double-blind, parallel group study performed on 20 consecutive patients scheduled for posterior spinal fusion surgery. Intraoperative bleeding was processed through a cell-saver: HaemoLite^® 2+, in which the RBCs were washed according to randomization group, with saline (control group) or saline+10μg/ml^-1 vancomycin (vanco group). Data regarding age, weight, processed and recovered volume, blood count, blood culture, and vancomycin concentration in RBCs concentrates obtained and incidence of fever after reinfusion were collected.

Results: Processed volume was 843±403ml and recovered volume 121±29ml, with haemoglobin concentration 10.4±5.0g/dl^-1 and haematocrit 29.1±15.9% (mean±SD). Recovered RBC concentrate cultures were positive for coagulase-negative Staphylococcus in 5 cases (50%) of the control group while all cultures were negative in the vanco group (P=.016). The difference between the theoretical concentration of vancomycin administered and the concentration determined in the recovered RBC concentrate was 1.31μg/ml^-1 (95% CI 1.19 to 1.43; P=.074).

Conclusions: The addition of vancomycin at a concentration of 10ug/ml^-1 to the wash solution of the cell-saver achieved similar concentrations in the autologous blood concentrate recovered allowing for bacterial removal, with negative blood cultures in all cases.

Keywords: Alternativas a la transfusión; Anti-bacterial agents; Antibióticos; Autologous blood transfusion; Bloodless medical and surgical procedures; Escoliosis; Intraoperative blood salvage; Recuperación de sangre operatoria; Scoliosis; Transfusión de sangre autógena; Vancomicina; Vancomycin.