Intraoperative Vancomycin Powder Reduces Staphylococcus aureus Surgical Site Infections and Biofilm Formation on Fixation Implants in a Rabbit Model

Abstract

Infection is a common complication of surgery, especially with implants. Simple methods to prevent or decrease the occurrence of infection would benefit the patient and the health care system.

Topical rifampin powder for orthopaedic trauma part II: Topical rifampin allows for spontaneous bone healing in sterile and contaminated wounds

“…The animals treated with rifampin show no clinical indications of infection, such as purulence or histological bacteria, thus allowing for natural and endogenous bone fracture repair of the femur. To our knowledge, this is the first time that antibiotic powders, like vancomycin and rifampin, have been evaluated in a preclinical model and shown to have no impact on bone formation …”

Bacterial biofilm formation on implantable devices and approaches to its treatment and prevention

“…There is an estimated 220,000 cases of nosocomial infections resulting in more than 8,000 deaths every year in Canada [108]. The most common post-operative complication is surgical site infections (SSIs) that arise at the exposed site of the body where the surgery took place, constituting between one fourth and one-third of all nosocomial infections, which accounted for 6–23% in most studies [109, 110, 111, 112]. In the US, it is estimated that more than 500,000 SSIs occur each year, at a rate of 2.8 per 100 operations [112].…”

“…Albumin adsorbed on material surfaces has also been found to inhibit bacterial adhesion to polymers, ceramics, and a variety of metal surfaces [145, 146]. Intraoperative vancomycin powder application at the time of implantation has also shown efficacy in decreasing biofilm formation in a rabbit model [109]. A technique, named as the antimicrobial lock technique, can also be employed to inhibit biofilm formation in catheters [38, 72, 126].…”

Improve Integration of In Vitro Biofilm Body of Knowledge to Support Clinical Breakthroughs in Surgical Site Infection

“… 36 Despite this 1000x˙ range, clinicians are known to apply vancomycin powder directly onto sensitive infected tissue in extreme cases. 37 , 38 This implies that microbial tolerance to vancomycin in these likely biofilm cases exceeds its cytotoxicity, and clinicians must balance causing tissue damage against decreasing microbial bioburden, possibly with little success. 38 , 39 , 40 In point of fact, we are unaware of how a clinician could request evaluation of the biofilm equivalent of MIC, the minimum biofilm eradication concentration (MBEC), of vancomycin or any other antibiotic for a patient in distress.…”

“… 37 , 38 This implies that microbial tolerance to vancomycin in these likely biofilm cases exceeds its cytotoxicity, and clinicians must balance causing tissue damage against decreasing microbial bioburden, possibly with little success. 38 , 39 , 40 In point of fact, we are unaware of how a clinician could request evaluation of the biofilm equivalent of MIC, the minimum biofilm eradication concentration (MBEC), of vancomycin or any other antibiotic for a patient in distress. 41 A paucity of standards, regulation, and guidance for the diagnosis and treatment of biofilm-related infection must be addressed concurrent to ongoing research.…”