Vancomycin Powder Use in Fractures at High Risk of Surgical Site Infection.
Journal
Journal of orthopaedic trauma
ISSN: 1531-2291
Titre abrégé: J Orthop Trauma
Pays: United States
ID NLM: 8807705
Informations de publication
Date de publication:
01 01 2021
01 01 2021
Historique:
accepted:
10
06
2020
pubmed:
9
9
2020
medline:
22
6
2021
entrez:
8
9
2020
Statut:
ppublish
Résumé
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. Retrospective analysis. Level I trauma center. 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. Topical vancomycin powder at wound closure. 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. 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). 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. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Identifiants
pubmed: 32898082
pii: 00005131-202101000-00006
doi: 10.1097/BOT.0000000000001863
doi:
Substances chimiques
Anti-Bacterial Agents
0
Powders
0
Vancomycin
6Q205EH1VU
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
23-28Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
R. Qadir and his institution received research support funding for this work from AO North America. No other outside source of funding was obtained for this study. R. V. O'Toole is a paid consultant for CoorsTek, Imagen, and Smith & Nephew, receives stock options from Imagen, and receives royalties from CoorsTek, unrelated to this study. He is currently the Principal Investigator on Department of Defense–funded randomized controlled trial on the same topic. M. Joshi has received payment for consultancy and development of educational presentations from Pfizer, Forest, and Atox. Her institution has current grants from Atox. The remaining authors report no conflict of interest.
Références
Buckholz RW, Heckman JD, Court-Brown C, et al. Rockwood and Green's Fractures in Adults. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2005.
Teeny SM, Wiss DA. Open reduction and internal fixation of tibial plafond fractures: variables contributing to poor results and complications. Clin Orthop Relat Res . 1993;292:108–117.
Heier KA, Infante AF, Walling AK, et al. Open fractures of the calcaneus: soft-tissue injury determines outcome. J Bone Joint Surg Am. 2003;85:2276–2282.
Thornton SJ, Cheluitte D, Ptaszek AJ, et al. Treatment of open intraarticular calcaneal fractures: evaluation of a treatment protocol based on wound location and size. Foot Ankle Int. 2006;27:317–323.
Young MJ, Barrack RL. Complications of internal fixation of tibial plateau fractures. Orthop Rev. 1994;23:149–154.
Stall A, Paryavi E, Gupta R, et al. Perioperative supplemental oxygen to reduce surgical site infection after open fixation of high-risk fractures: a randomized controlled pilot trial. J Trauma Acute Care Surg. 2013;75:657–663.
Stannard JP, Volgas DA, McGwin G III, et al. Incisional negative pressure wound therapy after high-risk lower extremity fractures. J Orthop Trauma. 2012;26:37–42.
Darouiche RO. Treatment of infections associated with surgical implants. N Engl J Med. 2004;350:1422–1429.
Qadir R, Sidhu S, Ochsner JL, et al. Risk stratified usage of antibiotic-loaded bone cement for primary total knee arthroplasty: short term infection outcomes with a standardized cement protocol. J Arthroplasty. 2014;29:1622–1624.
Kapadia BH, McElroy MJ, Issa K, et al. The economic impact of periprosthetic infections following total knee arthroplasty at a specialized tertiary-care center. J Arthroplasty. 2014;29:929–932.
O'Neill KR, Smith JG, Abtahi AM, et al. Reduced surgical site infections in patients undergoing posterior spinal stabilization of traumatic injuries using vancomycin powder. Spine J. 2011;11:641–646.
Sweet FA, Roh M, Sliva C. Intrawound application of vancomycin for prophylaxis in instrumented thoracolumbar fusions: efficacy, drug levels, and patient outcomes. Spine (Phila Pa 1976). 2011;36:2084–2088.
Bridwell KH, Anderson PA, Boden SD, et al. What's new in spine surgery. J Bone Joint Surg Am . 2013;95:1144–1150.
Gans I, Dormans JP, Spiegel DA, et al. Adjunctive vancomycin powder in pediatric spine surgery is safe. Spine (Phila Pa 1976) . 2013;38:1703–1707.
Strom RG, Pacione D, Kalhorn SP, et al. Decreased risk of wound infection after posterior cervical fusion with routine local application of vancomycin powder. Spine (Phila Pa 1976) . 2013;38:991–994.
Pahys JM, Pahys JR, Cho SK, et al. Methods to decrease postoperative infections following posterior cervical spine surgery. J Bone Joint Surg Am . 2013;95:549–554.
Caroom C, Tullar JM, Benton EG Jr, et al. Intrawound vancomycin powder reduces surgical site infections in posterior cervical fusion. Spine (Phila Pa 1976) . 2013;38:1183–1187.
Godil SS, Parker SL, O'Neil KR, et al. Comparative effectiveness and cost-benefit analysis of local application of vancomycin powder in posterior spinal fusion for spine trauma. J Neurosurg Spine . 2013;19:331–335.
Tubaki VR, Rajasekaran S, Shetty AP. Effects of using intravenous antibiotic only versus local intrawound vancomycin antibiotic only versus local intrawound vancomycin antibiotic powder application in addition to intravenous antibiotics on postoperative infection in spine surgery in 907 patients. Spine (Phila Pa 1976) . 2013;38:2149–2155.
Wukich DK, Dikis JW, Monaco SJ, et al. Topically applied vancomycin powder reduces the rate of surgical site infection in diabetic patients undergoing foot and ankle surgery. Foot Ankle Int. 2015;36:1017–1024.
Singh K, Bauer JM, LaChaud GY, et al. Surgical site infection in high-energy peri-articular tibia fractures with intra-wound vancomycin powder: a retrospective pilot study. J Orthop Traumatol. 2015;16:287–291.
Torbert JT, Joshi M, Moraff A, et al. Current bacterial speciation and antibiotic resistance in deep infections after operative fixation of fractures. J Orthop Trauma. 2015;29:7–17.
Lewallen S, Courtright P. Epidemiology in practice: case-control studies. Commun Eye Health. 1998;11:57–58.
Linden A, Samuels SJ. Using balance statistics to determine the optimal number of controls in matching studies. J Eval Clin Pract. 2013;19:968–975.
Tennent DJ, Shiels SM, Sanchez CJ Jr, et al. Time-dependent effectiveness of locally applied vancomycin powder in a contaminated traumatic orthopaedic wound model. J Orthop Trauma . 2016;30:531–537.
Qadir R, Ochsner JL, Chimento GF, et al. Establishing a role for vancomycin powder application for prosthetic joint infection prevention: results of a wear simulation study. J Arthroplasty . 2014;29:1449–1456.
Hovis JP, Montalvo R, Marinos D, et al. Intraoperative vancomycin powder reduces Staphylococcus aureus surgical site infections and biofilm formation on fixation implants in a rabbit model. J Orthop Trauma . 2018;32:263–268.
Ruffolo MR, Gettys FK, Montijo HE, et al. Complications of high-energy bicondylar tibial plateau fractures treated with dual plating through 2 incisions. J Orthop Trauma . 2015;29:85–90.
Blauth M, Bastian L, Krettek C, et al. Surgical options for the treatment of severe tibial pilon fractures: a study of three techniques. J Orthop Trauma. 2001;15:153–160.
McFerran MA, Smith SW, Boulas HJ, et al. Complications encountered in the treatment of pilon fractures. J Orthop Trauma . 1992;6:195–200.
Wyrsh B, McFerran MA, McAndrew M, et al. Operative treatment of fractures of the tibial plafond: a randomized, prospective study. J Bone Joint Surg Am . 1996;78:1646–1657.
Grose A, Gardner MJ, Hettrich C, et al. Open reduction and internal fixation of tibial pilon fractures using a lateral approach. J Orthop Trauma. 2007;21:530–537.
Benirschke SK, Kramer PA. Wound healing complications in closed and open calcaneal fractures. J Orthop Trauma. 2004;18:1–6.
Bibbo C, Patel DV. The effect of demineralized bone matrix-calcium sulfate with vancomycin on calcaneal fracture healing and infection rates: a prospective study. Foot Ankle Int. 2006;27:487–493.
Koski A, Kuokkanen H, Tukiainen E. Postoperative wound complications after internal fixation of closed calcaneal fractures: a retrospective analysis of 126 consecutive patients with 148 fractures. Scand J Surg. 2005;94:243–245.
King G, Nielsen R. Why propensity scores should not be used for matching. Polit Anal. 2019;27:435–454.
O'Toole RV, Joshi M, Carlini AR, et al. Local antibiotic therapy to reduce infection after operative treatment of fractures at high risk of infection: a multicenter, randomized, controlled trial (VANCO study). J Ortho Trauma 2017;31:S18–S24.