Is Topical Vancomycin an Option? A Randomized Controlled Trial to Determine the Safety of the Topical Use of Vancomycin Powder in Preventing Postoperative Infections in Total Knee Arthroplasty, as Compared With Standard Postoperative Antibiotics

Abuzaiter, Wesam; Bolton, Caralee; Drakos, Anastasia; Drakos, Paul G.; Hallan, Alam; Warchuk, David; Woolfrey, Karen; Woolfrey, Michael

doi:10.1016/j.arth.2023.01.040

Cited by 5 publications

(4 citation statements)

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“…A total of 1759 papers were found, and 22 qualified studies were selected for final analysis [ 11 – 32 ]. There were 23,363 cases in total, including 9545 cases in the preventive vancomycin group and 13,818 cases in the control group.…”

Section: Resultsmentioning

confidence: 99%

Prophylactic use of vancomycin powder on postoperative infection after total joint arthroplasty

Gao,

Shu,

Jiang

et al. 2024

BMC Musculoskelet Disord

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Objective By reviewing the literature analyzing vancomycin powder for preventive surgery, the effect of this method on reducing the infection rate after TJA was systematically evaluated to provide a basis for future clinical work. Methods Using PubMed, Medline, Elsevier, and CNKI, with the following mesh words: “vancomycin”, “local / intraoperative / topical / intrawound”, “TJA”, “TKA”, “THA”, “total joint arthroplasty”, “total knee arthroplasty”, “total hip arthroplasty”, “infection”, and “SSI”, to search for case-control research papers on the impact of prophylactic application of vancomycin powder on the incidence of postoperative infection, we compared the overall infection rate in the literature by using RevMan 5.3 meta-analysis software and analyzed the impact of vancomycin on the infection rate of different parts and types of TJA according to different subgroups. Results A total of 22 qualified studies were selected; twenty-five studies compared the effect of prophylactic use of vancomycin powder on infection rates after TJA. There were 23,363 cases in total, including 9545 cases in the vancomycin group and 13,818 cases in the control group. The results of the meta-analysis showed that the possibility of postoperative infection after prophylactic use of vancomycin powder was significantly lower than that without vancomycin risk ratio: 0.38 [0.23,0.59], P < 0.01). However, a meta-analysis of randomized controlled trials (RCTs) showed no significant effect of vancomycin on postoperative infection (P = 0.52). Conclusion Based on the retrospective studies, local prophylactic use of vancomycin powder in TJA can significantly reduce the incidence of postoperative infection. High-quality RCTs should be carried out to further evaluate these results.

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Section: Resultsmentioning

confidence: 99%

Prophylactic use of vancomycin powder on postoperative infection after total joint arthroplasty

Gao,

Shu,

Jiang

et al. 2024

BMC Musculoskelet Disord

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“…The publication years of the included articles ranged from 2008 to 2023. Among them, 8 articles compared ALBC with negative control (NC) [23][24][25][26][27][28][29][30], 9 articles compared chlorhexidine bathing with NC [31][32][33][34][35][36][37][38][39], 4 articles compared povidone iodine lavage with NC [40][41][42][43], and 14 articles compared vancomycin with NC [13,[44][45][46][47][48][49][50][51][52][53][54][55][56]]. In addition, 2 articles compared chlorhexidine and povidone iodine bathing [57,58], and 1 article compared povidone iodine bathing, vancomycin powder and NC [59].…”

Section: Search Results and Study Characteristicsmentioning

confidence: 99%

“…In previous studies, compared with NC, some studies showed lower SSI or PJI incidence after using vancomycin, ALBC, and povidone iodine [10, 13, 27, 30-38, 46-49, 51, 52, 59], but some showed opposite results[28, 41,44,54,56] or no signi cant differences [23-26, 29, 39, 40, 43, 45, 50, 53, 55]. Most studies showed a lower risk of SSI or PJI incidence after using chlorhexidine.…”

Section: Discussionmentioning

confidence: 99%

The effect of different preventive strategies during total joint arthroplasty on surgical site infection: a network meta-analysis

Wu,

Xiang,

2023

Preprint

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BackgroundPeriprosthetic joint infection or surgical site infection after total joint arthroplasty has a large incidence, and it may often require two or more stages of revision, placing an additional burden on clinicians and patients. The purpose of this network meta-analysis is to evaluate the effect of four different preventive strategies during total joint arthroplasty on the prevention of surgical site infection. Methods The study protocol was registered at PROSPERO (CRD: 42023448868), and the literature search databases includedWeb of Science, PubMed, OVID Cochrane Central Register of Controlled Trials, OVID EMBASE, and OVID MEDLINE(R) ALL that metthe requirements. The network meta-analysis was performed by using randomized controlled trials, retrospective cohort studies and prospective cohort studies with the outcome of periprosthetic joint infection or surgical site infection incidence. The gemtc R package was applied to perform the network meta-analysis to evaluate the relative results of different preventive strategies. The heterogeneity test of direct and indirect evidence was also assessed by R software with the gemtc package. Results This network meta-analysis study included a total of 38 articles with 4 preventive strategies and negative control. No improvement was observed in antibiotic-loaded bone cement compared with negative control. Chlorhexidine showed the highest probability of delivering the best preventive effect, and povidone iodine had the second highest probability. Although vancomycin ranked after chlorhexidine and povidoneiodine, it still showed a significant difference compared with negative control. In addition, the incidence after applying chlorhexidine was significantly lower than that after applying negative control and vancomycin. In the heterogeneity test between direct and indirect evidence, there was no apparent heterogeneity between them. Conclusion The study indicated that chlorhexidine, povidoneiodine and vancomycinshowed significant efficacy in preventing periprosthetic joint infection or surgical site infection after total joint arthroplasty, while antibiotic-loaded bone cement did not. Therefore, more high-quality randomized controlled trials are needed to verify the results above.

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“…Patients who developed ipsilateral metachronous PJI had significantly shorter stem-to-stem (tip-to-tip) distances (8 compared with 14 cm; p < 0.01) and empty (no foreign body such as cement) native bone distances (5 compared with 11 cm; p < 0.01), as well as an elevated risk of cement extrusion beyond its restrictor (70% compared with 5%; p < 0.01) compared with patients who did not develop infection. Abuzaiter et al 59 conducted a noninferiority RCT to determine whether topical vancomycin powder is a valuable option for preventing infections after TKA. When compared with a standard postoperative antibiotics group (n = 85), patients who received 1 g of vancomycin powder intraoperatively and no postoperative antibiotics (n = 80) exhibited a greater rate of postoperative PJI (3.75% compared with 0%; p = 0.03).…”

Section: Revision Tkamentioning

confidence: 99%

What’s New in Adult Reconstructive Knee Surgery

Villa,

Hosseinzadeh,

Higuera-Rueda

2023

Journal of Bone and Joint Surgery

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In the current Guest Editorial, we evaluate and summarize the most relevant findings from recent, meaningful, peer-reviewed publications in different research areas. Articles at various Levels of Evidence were included, but increased attention was paid to Level-I and award-winning reports. EconomicsConsiderable debate continues with regard to the economics of reconstructive knee surgery. An updated Medicare projection revealed that, by 2040, the annual number of revision total knee arthroplasties (TKAs) performed would be 115,147, whereas, by 2060, it would be 286,740. These values are important for understanding the future health-care resource utilization involving revision TKA, which is only expected to increase 1 . A secondary analysis of a randomized clinical trial (RCT) evaluating health-care resource utilization up to 12 months after primary TKA, among dissatisfied and satisfied patients, showed that patients dissatisfied with their return to function incurred a mean cost of $19,007.70, compared with $13,523.83 for satisfied patients (p = 0.07). Although the cost difference was not significant, its magnitude deserves attention 2 . Data from the New Zealand Joint Registry indicated that patients undergoing TKA have a mortality rate 8% higher than that of the general population 3 . Assessing mortality after primary TKA is relevant for future economic analyses.

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Is Topical Vancomycin an Option? A Randomized Controlled Trial to Determine the Safety of the Topical Use of Vancomycin Powder in Preventing Postoperative Infections in Total Knee Arthroplasty, as Compared With Standard Postoperative Antibiotics

Cited by 5 publications

References 25 publications

Prophylactic use of vancomycin powder on postoperative infection after total joint arthroplasty

Prophylactic use of vancomycin powder on postoperative infection after total joint arthroplasty

The effect of different preventive strategies during total joint arthroplasty on surgical site infection: a network meta-analysis

What’s New in Adult Reconstructive Knee Surgery

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