Serum and Wound Vancomycin Levels After Intrawound Administration in Primary Total Joint Arthroplasty

Johnson, Jeremiah X.; Nessler, Joseph M.; Horazdovsky, Ryan D.; Vang, Sandy; Thomas, Avis J.; Marston, Scott B.

doi:10.1016/j.arth.2015.10.015

Cited by 59 publications

(46 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, only the revision procedures demonstrated a significant reduction in the rate of early post-operative infections in their study. Regarding the safety of the VP application for total joint arthroplasty, Johnson et al [18] measured serum and wound concentrations of vancomycin after intrawound VP administration. They reported that VP reached highly therapeutic intrawound concentrations while yielding low systemic levels after total joint arthroplasty.…”

Section: Discussionmentioning

confidence: 99%

No Decrease in Infection Rate with the Use of Local Vancomycin Powder After Partial Hip Replacement in Elderly Patients with Comorbidities

Erken

Nusran

Karagüven

et al. 2020

Cureus

View full text Add to dashboard Cite

The goal of this study was to evaluate the effects of local intra-wound vancomycin powder (VP) administration to decrease surgical site infections (SSIs), particularly in elderly patients with comorbidities, after having undergone partial hip replacement in the treatment of intertrochanteric (ITF) or femoral neck fractures (FNF). Methods We retrospectively reviewed patients who underwent partial hip replacement in the treatment of ITF or FNF in one year. We divided the patients into two groups. The non vancomycintreated group received standard systemic prophylaxis only (1 gr cefazolin IV), while the vancomycin-treated group received 1 gr of VP in the surgical wound just before surgical closure in addition to the systemic prophylaxis. We included patients of 64 years or older who also had one or more comorbidities. We compared the post-operative SSI rates between the non vancomycin-treated group and the vancomycin-treated group. Results A total of 93 patients were included in the study. We detected post-operative wound infection in six patients (6.4%). The rate of SSI was found to be 5.7% in the vancomycin-treated group and 6.9% in the non vancomycin-treated group respectively, which showed no statistically significant difference (p:0.498). The incidence of SSI was statistically higher in the patients who had a follow-up in the post-operative intensive care unit than the patients who had not any follow-up in the intensive care unit. Conclusion Local application of VP in the surgical wound was found to be ineffective in reducing the incidence of SSI after partial hip replacement in elderly patients with comorbidities.

show abstract

Section: Discussionmentioning

confidence: 99%

No Decrease in Infection Rate with the Use of Local Vancomycin Powder After Partial Hip Replacement in Elderly Patients with Comorbidities

Erken

Nusran

Karagüven

et al. 2020

Cureus

View full text Add to dashboard Cite

show abstract

“…Similarly, an investigation by Johnson et al. [10] attested to the safety of using 2 g of intraarticular vancomycin powder in arthroplasty surgery. They found highly therapeutic vancomycin concentrations in the local tissue yet at low systemic levels.…”

Section: Discussionmentioning

confidence: 99%

“…Johnson et al. [10] recently published data supporting the safety of vancomycin powder placed intraarticularly after arthroplasty. Although there is basic science and spine literature supporting the use of intrawound vancomycin powder, there is a paucity of clinical data in its efficacy for prevention of PJI.…”

Section: Introductionmentioning

confidence: 99%

Intrawound vancomycin in primary hip and knee arthroplasty: a safe and cost-effective means to decrease early periprosthetic joint infection

2018

View full text Add to dashboard Cite

BackgroundPeriprosthetic joint infection (PJI) is a devastating complication after hip and knee arthroplasty. Intrawound vancomycin has been described extensively in the spine literature; however, information regarding use in arthroplasty is limited. We investigate the efficacy and safety of intrawound vancomycin in arthroplasty surgery.MethodsAll primary total hip and knee arthroplasty cases (n = 460) performed by a single surgeon from April 2016 to October 2017 were reviewed. Starting in October 2016, intrawound vancomycin was used in all total joints. Baseline characteristics, infection rates, 90-day readmission, and other complications were compared between untreated subjects and those who received intrawound vancomycin. In addition, cost data were considered. Mean follow-up durations for the control and vancomycin groups were 11.3 and 7.7 months, respectively.ResultsBaseline characteristics and comorbidities were similar for the control (n = 112) and vancomycin groups (n = 348). The vancomycin cohort demonstrated decreased both overall infection rate (0.57% vs 2.7%; P = .031) and PJI rate (0.29% vs 2.7%; P = .009) compared with the untreated group. There was no statistical difference in incidence of ototoxicity or acute kidney injury. Although there was no difference in overall 90-day readmission rate, the vancomycin subset demonstrated lower readmission rate due to infection (0.57% vs 2.7%; P = .031). Based on the cost of vancomycin powder and calculated number needed to treat (NNT = 47.5), the cost to prevent 1 infection with the addition of intrawound vancomycin was $816.ConclusionsThese findings suggest that intrawound vancomycin may be a safe, cost-effective means that shows promise in reducing PJI in early follow-up. Future prospective studies are warranted.

show abstract

“…The routine use of antibiotic‐loaded bone cement for cemented primary hip and knee arthroplasty is controversial, and it has not shown consistent efficacy or cost‐effectiveness in large scale studies to justify routine use in the United States 8,9,51 . Local administration of vancomycin powder may be effective in reducing PJI rates after complex spine surgery; however, low‐quality data have demonstrated there may only be a slight decrease in PJI risk when used preventatively in TJA and may increase rates of wound seroma 52–54 . Intraoperative antiseptic prophylactic irrigation solutions have become more popular in the past decade.…”

Section: New Advancements In Prevention Of Pjimentioning

confidence: 99%

New developments and future challenges in prevention, diagnosis, and treatment of prosthetic joint infection

Ricciardi

Muthukrishnan

Masters

et al. 2020

Journal Orthopaedic Research

View full text Add to dashboard Cite

Prosthetic joint infection (PJI) is a devastating complication that results in substantial costs to society and patient morbidity. Advancements in our knowledge of this condition have focused on prevention, diagnosis, and treatment, in order to reduce rates of PJI and improve patient outcomes. Preventive measures such as optimization of patient comorbidities, and perioperative antibiotic usage are intensive areas of current clinical research to reduce the rate of PJI. Improved diagnostic tests such as synovial fluid (SF) α‐defensin enzyme‐linked immunosorbent assay, and nucleic acid‐based tests for serum, SF, and tissue cultures, have improved diagnostic accuracy and organism identification. Increasing the diversity of available antibiotic therapy, immunotherapy, and alternative implant coatings remain promising treatments to improve infection eradication in the setting of PJI.

show abstract

Serum and Wound Vancomycin Levels After Intrawound Administration in Primary Total Joint Arthroplasty

Cited by 59 publications

References 21 publications

No Decrease in Infection Rate with the Use of Local Vancomycin Powder After Partial Hip Replacement in Elderly Patients with Comorbidities

No Decrease in Infection Rate with the Use of Local Vancomycin Powder After Partial Hip Replacement in Elderly Patients with Comorbidities

Intrawound vancomycin in primary hip and knee arthroplasty: a safe and cost-effective means to decrease early periprosthetic joint infection

New developments and future challenges in prevention, diagnosis, and treatment of prosthetic joint infection

Contact Info

Product

Resources

About