Surgical site infection in high-energy peri-articular tibia fractures with intra-wound vancomycin powder: a retrospective pilot study

Abstract

BackgroundSurgical site infections (SSI) continue to be a significant source of morbidity despite the introduction of perioperative intravenous antibiotics. Our objective was to assess the efficacy of local vancomycin powder on lowering deep SSI rates in high-energy tibial plateau and pilon fractures.Materials and methodsA retrospective review of all tibial plateau and pilon fractures treated in 2012 at our level I trauma center identified 222 patients. Of these, 107 patients sustained high-energy injuries that required staged fixation, and 93 had minimum 6 month follow-up. Ten patients received 1 gram vancomycin powder directly into the surgical wound at the time of definitive fixation, and the remaining 83 patients served as controls. SSI was defined according to criteria from the Centers for Disease Control. Demographic data, patient comorbidities, injury and treatment details, and infection details were recorded. Descriptive and comparative statistics were performed.ResultsAmongst the vancomycin powder group, 1 patient (10 %) developed a deep SSI; in the control group, 14 (16.7 %) developed deep SSI. The rate of deep SSI between the groups was not statistically significantly different (P = 1.0). The groups were statistically similar with regard to injuries, treatment, comorbidities, and infectious outcomes (P values range = 0.06–1.0).ConclusionsThe application of local vancomycin powder into surgical wounds of high-energy tibial plateau and pilon fractures did not reduce the rate of deep SSI in this retrospective review. There is a need to find effective, cheap, and widely available methods for prevention of SSI. Basic science and larger prospective clinical studies are needed to further delineate the role of local vancomycin powder as a modality to reduce deep SSI in extremity trauma.Level of evidence Level III, therapeutic.

Prevention of fracture-related infection: a multidisciplinary care package

“…Furthermore, hypothermia affects leukocyte migration, neutrophil phagocytosis and cytokine production, causing a depression of the immune system and therefore a delay in wound healing [94][95][96]. Until recently, the hypothesis was that these consequences-impaired immune function and delayed wound healing-increase the risk of SSI [67,95,96]. Brown et al recently countered this hypothesis, as they found no significant correlation between the development of SSI and perioperative hypothermia.…”

“…Studies show that local administration of antibiotics could have a positive influence on infection prevention [67][68][69]. Local prophylaxis can be administered by cement spacers, which are made of polymethyl methacrylate (PMMA), collagens, coatings (e.g.…”

Topical rifampin powder for orthopedic trauma part I: Rifampin powder reduces recalcitrant infection in a delayed treatment musculoskeletal trauma model

“…Local antimicrobial powder application has been introduced as an adjunctive therapy for perioperative antibiotics to decrease the rate of surgical site infection . Currently used prophylactically, the inclusion of vancomycin powder has resulted in up to a fourfold decrease of surgical site infection in spine surgery, a 73% infection reduction in diabetic foot and ankle surgery and is being evaluated for its utility in fracture surgery patients at high risk for infection . If a contaminated open wound is treated early enough, it may be possible to reduce infection by the application of vancomycin powder to the wound .…”

Cerrahi Alan İnfeksiyonlarının Profilaksisinde Lokal Vankomisin Uygulaması

“…[65] 1512 Singh ve ark. [68] 93 Retrospektif Ortopedik travma cerrahisi 93 hastanın 10'unda intravenöz sefazolin yanı sıra 1 g lokal vankomisin kullanılmıştır. Kontrol grubundaki hastaların %16.7'sine kıyasla, vankomisin profilaksisi alan grupta hastaların %10'unda derin CAİ gelişmiş, bu fark anlamlı düzeyde bulunmamıştır.…”