Intraoperative Topical Antibiotics for Infection Prophylaxis in Pelvic and Acetabular Surgery

Owen, Matthew T.; Keener, Emily; Hyde, Zane; Crabtree, Reaves M.; Hudson, Parke; Griffin, Russell; Lowe, Jason

doi:10.1097/bot.0000000000000941

Cited by 43 publications

(47 citation statements)

References 39 publications

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“…A previous meta-analysis with a limited quality of evidence showed a significant protective effect of topical vancomycin powder in reducing SSI rate in spinal surgery. 44 Owen et al 45 reported in a recently published cohort study a significant reduction of postoperative infection if vancomycin or tobramycin powder were applied in pelvic/acetabular fracture surgery. In open articular tibial fractures, Singh et al 18 found no beneficial effect of topical vancomycin, although this study is associated with a considerable risk of bias due to a small sample size and inadequate reporting of soft-tissue involvement and length of follow-up.…”

Section: Discussionmentioning

confidence: 99%

The effect of local antibiotic prophylaxis when treating open limb fractures

Morgenstern

Vallejo²,

McNally

et al. 2018

Bone & Joint Research

116

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ObjectivesAs well as debridement and irrigation, soft-tissue coverage, and osseous stabilization, systemic antibiotic prophylaxis is considered the benchmark in the management of open fractures and considerably reduces the risk of subsequent fracture-related infections (FRI). The direct application of antibiotics in the surgical field (local antibiotics) has been used for decades as additional prophylaxis in open fractures, although definitive evidence confirming a beneficial effect is scarce. The purpose of the present study was to review the clinical evidence regarding the effect of prophylactic application of local antibiotics in open limb fractures.MethodsA comprehensive literature search was performed in PubMed, Web of Science, and Embase. Cohort studies investigating the effect of additional local antibiotic prophylaxis compared with systemic prophylaxis alone in the management of open fractures were included and the data were pooled in a meta-analysis.ResultsIn total, eight studies which included 2738 patients were eligible for quantitative synthesis. The effect of antibiotic-loaded poly(methyl methacrylate) beads was investigated by six of these studies, and two studies evaluated the effect of local antibiotics applied without a carrier. Meta-analysis showed a significantly lower infection rate when local antibiotics were applied (4.6%; 91/1986) than in the control group receiving standard systemic prophylaxis alone (16.5%; 124/752) (p < 0.001) (odds ratio 0.30; 95% confidence interval 0.22 to 0.40).ConclusionThis meta-analysis suggests a risk reduction in FRI of 11.9% if additional local antibiotics are given prophylactically for open limb fractures. However, due to limited quality, heterogeneity, and considerable risk of bias, the pooling of data from primary studies has to be interpreted with caution.Cite this article: M. Morgenstern, A. Vallejo, M. A. McNally, T. F. Moriarty, J. Y. Ferguson, S. Nijs, WJ. Metsemakers. Bone Joint Res 2018;7:447–456. The effect of local antibiotic prophylaxis when treating open limb fractures: A systematic review and meta-analysis. DOI: 10.1302/2046-3758.77.BJR-2018-0043.R1

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Section: Discussionmentioning

confidence: 99%

The effect of local antibiotic prophylaxis when treating open limb fractures

Morgenstern

Vallejo²,

McNally

et al. 2018

Bone & Joint Research

116

View full text Add to dashboard Cite

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“…Furthermore, calcium sulfate use has been associated with aseptic seroma and wound drainage issues [13 , 41] . With regards to vancomycin-induced nephrotoxicity, previous orthopedic literature has not shown significant risk for renal injury with vancomycin powder [42][43][44] or vancomycinimpregnated calcium sulfate [16] . While these were not reported in the present study, further examination and vigilance is needed for these issues in the continued use of calcium sulfate adjuncts.…”

Section: Discussionmentioning

confidence: 97%

Vancomycin-impregnated calcium sulfate beads compared with vancomycin powder in adult spinal deformity patients undergoing thoracolumbar fusion

Xiong

Fogel

Tobert

et al. 2021

North American Spine Society Journal (NASSJ)

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Introduction Adult spinal deformity (ASD) surgery patients are at higher risk for surgical site infections (SSIs) due to large incisions, high blood loss, long surgical duration, and extensive instrumentation. The use of vancomycin powder has demonstrated inconsistent results in ASD surgery. Antibiotic-impregnated calcium sulfate beads have been used in arthroplasty and foot and ankle surgery with promising results. The purpose of this study was to provide preliminary data on the use of vancomycin-impregnated calcium sulfate beads in the prevention of SSI following ASD surgery and provide comparisons to the use of vancomycin powder. Methods A retrospective chart review was performed for 95 consecutive surgical ASD patients at a tertiary care center from January 2017 until March 2020. Patients received either vancomycin powder (powder group) or vancomycin-impregnated calcium sulfate beads (bead group) intrawound prior to closure. Patient demographics, operative course, and incidence of postoperative infections were recorded. A two-tailed chi-squared test was performed to compare infection rates. Results Ninety-five patients were included for review. Forty-two patients were in the powder group and 53 patients were in the bead group. The bead group was older (59.8 vs 67.8 years, p < 0.01) with similar BMI and rates of diabetes, smoking, and length of surgery. There were four postoperative SSI in the powder group requiring operative irrigation and debridement and one SSI in the bead group (9.5% vs 1.9%, p = 0.09). All infections occurred in the first 90 days of the postoperative period. Conclusion Preliminary examination of the use of vancomycin-impregnated calcium sulfate beads demonstrated a 1.9% surgical site infection rate in adult spinal deformity surgical patients, which was not significantly different compared with the 9.5% infection rate in patients who received vancomycin powder. Prospective study is needed to determine if the differences found are significant in a larger number of patients.

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“…While Stoppa and modified Stoppa approach have shown lower rates of blood loss than the ilioinguinal approach, 23 no difference in infection or complication rate has been reported to date after pelvic fracture stabilization. 24 It has been proposed that topical antibiotics may reduce the incidence of surgical site infection after open pelvic and acetabulum fixation, 25 which may be a viable infection reduction strategy in high-risk patients.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for complications following pelvic ring and acetabular fractures: A retrospective analysis at an urban level 1 trauma center

Henstenburg

Larwa

Williams

et al. 2021

Journal of Orthopaedics, Trauma and Rehabilitation

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Background: Pelvic ring and acetabular fractures are some of the most morbid in orthopedic trauma. They commonly require large exposures for fixation and are associated with significant morbidity and mortality. This study attempts to identify risk factors for complications following operative fixation of pelvic injuries. Methods: 126 patients treated for pelvic injuries were reviewed retrospectively. Demographics, procedure characteristics, and outcomes were recorded. Variables associated with complications were analyzed using logistic regression analysis. Results: Complications occurred in 12 patients. Higher BMI, longer length of stay, and ilioinguinal approach were significantly associated with increased infection risk. Co-morbid heart disease and concurrent smoking status showed a trend for increased infection risk. Higher BMI and ilioinguinal approach were significantly associated with an increased likelihood of re-operation. Positive psychiatric history and Medicaid payer status showed a trend toward higher reoperation risk. Conclusion: Knowledge of these risk factors can help guide management and predict outcomes following pelvic fracture fixation.

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Intraoperative Topical Antibiotics for Infection Prophylaxis in Pelvic and Acetabular Surgery

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

Cited by 43 publications

References 39 publications

The effect of local antibiotic prophylaxis when treating open limb fractures

The effect of local antibiotic prophylaxis when treating open limb fractures

Vancomycin-impregnated calcium sulfate beads compared with vancomycin powder in adult spinal deformity patients undergoing thoracolumbar fusion

Risk factors for complications following pelvic ring and acetabular fractures: A retrospective analysis at an urban level 1 trauma center

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