Abstract | OBJECTIVE: To determine whether a Bayesian analysis changes the results of the VANCO trial. DESIGN: A secondary analysis of a randomized clinical trial using Bayesian methods. SETTING: Thirty-six US trauma centers. PATIENTS: Patients ages 18-80 years with a tibial plateau or pilon fracture deemed high risk of infection and definitively treated with plate and screw fixation. INTERVENTION: Patients were randomly allocated to receive 1000 mg of intrawound vancomycin powder at their definitive fixation or to a control group that received no topical antibiotics. MAIN OUTCOME MEASUREMENTS: RESULTS: Of the 980 patients randomized, 874 (89%) had at least 140 days of follow-up and were included in this Bayesian analysis. The estimated probability that intrawound vancomycin powder reduces the risk of a deep surgical site infection is >98% [relative risk (RR), 0.66; 95% credible interval (CrI), 0.46-0.98]. There is a >99% chance intrawound vancomycin powder reduces gram-positive infections and an 80% chance the magnitude of this risk reduction exceeds 35% (RR, 0.52; 95% CrI, 0.33-0.84) exists. It is unlikely (44%) that intrawound vancomycin powder prevents gram-negative surgical site infections (RR, 1.06; 95% CrI, 0.48-2.45). CONCLUSIONS: LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Authors | Nathan N O'Hara, Renan C Castillo, Anthony R Carlini, Manjari Joshi, Clinton K Murray, Lauren E Allen, Yanjie Huang, Joshua L Gary, Michael J Bosse, William T Obremskey, Todd O McKinley, Andrew H Schmidt, Robert V O'Toole, and METRC |
Journal | Journal of orthopaedic trauma
(J Orthop Trauma)
Vol. 37
Issue 1
Pg. 1-7
(01 01 2023)
ISSN: 1531-2291 [Electronic] United States |
PMID | 35830572
(Publication Type: Randomized Controlled Trial, Journal Article, Research Support, U.S. Gov't, Non-P.H.S.)
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Copyright | Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved. |
Chemical References |
- Vancomycin
- Powders
- Anti-Bacterial Agents
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Topics |
- Humans
- Adolescent
- Young Adult
- Adult
- Middle Aged
- Aged
- Aged, 80 and over
- Vancomycin
(therapeutic use)
- Surgical Wound Infection
(prevention & control, drug therapy)
- Bayes Theorem
- Powders
- Anti-Bacterial Agents
(therapeutic use)
- Tibial Fractures
(surgery, drug therapy)
- Retrospective Studies
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