Vancomycin Powder Use in Fractures at High Risk of Surgical Site Infection.

Abstract

OBJECTIVES:

To determine if the use of intrawound vancomycin powder reduces surgical-site infection after open reduction and internal fixation of bicondylar tibial plateau, tibial pilon, and calcaneus fractures.

DESIGN:

Retrospective analysis.

SETTING:

Level I trauma center.

PATIENTS:

All fractures operatively treated from January 2011 to February 2015 were reviewed; 583 high-risk fractures were included, of which 35 received topical vancomycin powder. A previously published prospectively collected cohort of 235 similar high-risk fractures treated at our center from 2007 through 2010 served as a second comparison group.

INTERVENTION:

Topical vancomycin powder at wound closure.

MAIN OUTCOME MEASUREMENTS:

Deep surgical-site infection. Analyses used both univariate comparison of all patients and 1:2 matching analysis using both nearest neighbor and propensity-based matching.

RESULTS:

Compared with a control group of fractures treated during the same time period without vancomycin powder, the infection rate with vancomycin powder was significantly lower [0% (0/35) vs. 10.6% (58/548), P = 0.04]. Compared with our previously published historical infection rate of 13% for these injuries, vancomycin powder was also associated with significantly decreased deep surgical-site infection (0% vs. 13%, P = 0.02). These results agreed with the matched analyses, which also showed lower infection in the vancomycin powder group (0% vs. 11%-16%, P ≤ 0.05).

CONCLUSIONS:

Vancomycin powder may play a role in lowering surgical-site infection rates after fracture fixation. A larger randomized controlled trial is needed to validate our findings.

LEVEL OF EVIDENCE:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

• Authors: Rabah Qadir, Timothy Costales, Max Coale, Alexandra Mulliken, Timothy Zerhusen Jr, Manjari Joshi, Renan C Castillo, Anthony R Carlini, Robert V O'Toole
• Journal: Journal of orthopaedic trauma (J Orthop Trauma) Vol. 35 Issue 1 Pg. 23-28 (01 01 2021) ISSN: 1531-2291 [Electronic] United States
• PMID: 32898082 (Publication Type: Journal Article)
• Copyright: Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Chemical References

• Anti-Bacterial Agents
• Powders
• Vancomycin

Topics

• Anti-Bacterial Agents (therapeutic use)
• Humans
• Powders
• Retrospective Studies
• Surgical Wound Infection (drug therapy, epidemiology, prevention & control)
• Tibial Fractures (drug therapy, surgery)
• Vancomycin