Intra-Articular Vancomycin Powder Eliminates Methicillin-Resistant S. aureus in a Rat Model of a Contaminated Intra-Articular Implant

Edelstein, Adam I.; Weiner, Joseph A.; Cook, Ralph W.; Chun, Danielle S.; Monroe, Emily; Mitchell, Sean M.; Kannan, Abhishek; Hsu, Wellington K.; Stulberg, S. David; Hsu, Erin L.

doi:10.2106/jbjs.16.00127

Cited by 49 publications

(40 citation statements)

References 52 publications

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“…In a mouse model, an intra-articular knee implant was surgically placed and bacterial colony counts were compared between a group who received intrawound vancomycin powder (VP) at the time of skin closure and a control group who received no VP. Bacterial colony counts were significantly decreased at the distal femur, joint capsule, and the implanted device in the VP group 16) . VP has been used by spine surgeons for a number of years and there is evidence demonstrating a reduction in surgical site infections.…”

Section: Introductionmentioning

confidence: 92%

Intrawound Vancomycin Powder in Primary Total Hip Arthroplasty Increases Rate of Sterile Wound Complications

et al. 2018

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PurposeTotal hip arthroplasty (THA) is a successful surgery for the treatment of hip osteoarthritis; however, the risk of a post-operative prosthetic joint infection (PJI) remains at 1% to 2%. The purpose of this study was to investigate the safety profile of using vancomycin powder (VP) to reduce infection rates by reviewing acute postoperative complications.Materials and MethodsA retrospective review of 265 consecutive patients undergoing THA was performed. The first 128 patients, the control group, did not receive VP, and the subsequent 137 patients, the VP group, received VP at the time of wound closure. Patient demographic data, medical comorbidities, and perioperative information were compared.ResultsThe primary outcome was a post-operative surgical complication within 90 days from surgery. The control and VP group's demographic, medical comorbidities and perioperative information data were statistically similar. Deep infection rate in the control group was 5.5%, whereas the deep infection rate in the VP group was 0.7% (P=0.031). Sterile wound complication rate was 4.4% in the VP group, and 0% in the control group (P=0.030). Remaining complications were not statistically different between the groups.ConclusionVP was associated with an increase rate of sterile wound complications compared to the control group. The rate of PJI was decreased with the use of VP. We do not recommend for or against the use of VP at time of wound closure to prevent PJI, and higher powered studies will need to be performed to demonstrate the efficacy of VP.

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Section: Introductionmentioning

confidence: 92%

Intrawound Vancomycin Powder in Primary Total Hip Arthroplasty Increases Rate of Sterile Wound Complications

et al. 2018

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“…They found considerable variation among all factors, demonstrating no clear consensus on SSI prevention in shoulder arthroplasty even among a homogenous group of surgeons 28 To combat SSI the intraoperative usage of topical antibiotic powder has gained considerable attention. Previous studies have investigated the use of topical vancomycin, [42][43][44] gentamicin, 45 and tobramycin 46 for a range of orthopedic surgical indications. Vancomycin is the most commonly utilized local antibiotic in powder form within orthopedic surgery and has been the source of multiple previous studies on prevention of SSIs.…”

Section: Discussionmentioning

confidence: 99%

Exploring Penicillin G as an Intrawound Antibiotic Powder for Prevention of Postoperative Shoulder Infections: Does It Exhibit In Vitro Chondrotoxicity?

Nadig

Shaw

Parada

2019

Journal Orthopaedic Research

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Cutibacterium acnes (C. acnes) is a significant insidious pathogen for postoperative infections in shoulder surgery. Studies have demonstrated that certain topical antibiotic powders used have the potential for chondrotoxicity. Benzylpenicillin, commonly referred to as Penicillin G (Pen G) has the lowest minimum inhibitory concentration (MIC) for C. acnes. There is no research regarding the topical application of Pen G during shoulder surgery, nor has its chondrocyte toxicity been previously investigated. This study sought to characterize the in vitro chondrocyte toxicity of Pen G. Culture‐derived bovine chondrocytes were exposed to serial Pen G concentrations and compared with a positive and negative control. A negative control of growth medium and positive control of 1% Triton solution. The chondrocyte viability was assessed via spectrophotometer absorbance. The treatment groups were analyzed using one‐way repeated measures analysis of variance and Pearson's correlation analysis. The chondrocyte viability was significantly higher for all Pen G concentrations as compared with the positive control (p < 0.001). All concentrations of Pen G exhibited continued chondrocyte metabolic activity over time. Analysis of variance, independent of time, demonstrated no significant decrease in chondrocyte viability for Pen G concentrations ≤6.25 mg/ml, as compared with the negative control (p > 0.05). Pen G demonstrated a significant negative correlation with its concentration and absorbance (r = 0.371, p < 0.001), however, concentrations ≤6.25 mg/ml did not demonstrate a significant decrease in chondrocyte viability (p = 0.063). Pen G in concentrations appropriate for C. acnes is not significantly chondrotoxic and may be safe for intrawound application. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:726‐730, 2020

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“…[21][22][23] However, these Dacron implants were more porous, and so the optimal systemic vancomycin dose for the metal discs may be higher. There have also been studies in rats on using vancomycin powder on infected orthopedic implants, 24,25 but that milieu is so different from the stimulator implant sites that the therapeutic doses cannot be compared. Finally, the disc implants were not made out of the same materials, as were the external cases of the different clinically available units from each manufacturer.…”

Section: Discussionmentioning

confidence: 99%

Local Vancomycin Effectively Reduces Surgical Site Infection at Implant Site in Rodents

Li¹,

Shafikhani

Gupta

et al. 2018

Regional Anesthesia and Pain Medicine

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Intra-Articular Vancomycin Powder Eliminates Methicillin-Resistant S. aureus in a Rat Model of a Contaminated Intra-Articular Implant

Abstract: This animal study presents data suggesting that the use of intra-articular vancomycin powder for reducing the risk of periprosthetic joint infections should be investigated further in clinical studies.

Cited by 49 publications

References 52 publications

Intrawound Vancomycin Powder in Primary Total Hip Arthroplasty Increases Rate of Sterile Wound Complications

Intrawound Vancomycin Powder in Primary Total Hip Arthroplasty Increases Rate of Sterile Wound Complications

Exploring Penicillin G as an Intrawound Antibiotic Powder for Prevention of Postoperative Shoulder Infections: Does It Exhibit In Vitro Chondrotoxicity?

Local Vancomycin Effectively Reduces Surgical Site Infection at Implant Site in Rodents

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