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. 2021 Jan 1;35(1):23-28.
doi: 10.1097/BOT.0000000000001863.

Vancomycin Powder Use in Fractures at High Risk of Surgical Site Infection

Rabah Qadir  1 , Timothy Costales  1 , Max Coale  1 , Alexandra Mulliken  1 , Timothy Zerhusen Jr  1 , Manjari Joshi  2 , Renan C Castillo  3 , Anthony R Carlini  3 , Robert V O'Toole  1
Affiliations

Vancomycin Powder Use in Fractures at High Risk of Surgical Site Infection

Rabah Qadir et al. J Orthop Trauma. .

Abstract

Objectives: To determine if the use of intrawound vancomycin powder reduces surgical-site infection after open reduction and internal fixation of bicondylar tibial plateau, tibial pilon, and calcaneus fractures.

Design: Retrospective analysis.

Setting: Level I trauma center.

Patients: All fractures operatively treated from January 2011 to February 2015 were reviewed; 583 high-risk fractures were included, of which 35 received topical vancomycin powder. A previously published prospectively collected cohort of 235 similar high-risk fractures treated at our center from 2007 through 2010 served as a second comparison group.

Intervention: Topical vancomycin powder at wound closure.

Main outcome measurements: Deep surgical-site infection. Analyses used both univariate comparison of all patients and 1:2 matching analysis using both nearest neighbor and propensity-based matching.

Results: Compared with a control group of fractures treated during the same time period without vancomycin powder, the infection rate with vancomycin powder was significantly lower [0% (0/35) vs. 10.6% (58/548), P = 0.04]. Compared with our previously published historical infection rate of 13% for these injuries, vancomycin powder was also associated with significantly decreased deep surgical-site infection (0% vs. 13%, P = 0.02). These results agreed with the matched analyses, which also showed lower infection in the vancomycin powder group (0% vs. 11%-16%, P ≤ 0.05).

Conclusions: Vancomycin powder may play a role in lowering surgical-site infection rates after fracture fixation. A larger randomized controlled trial is needed to validate our findings.

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

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Conflict of interest statement

R. Qadir and his institution received research support funding for this work from AO North America. No other outside source of funding was obtained for this study. R. V. O'Toole is a paid consultant for CoorsTek, Imagen, and Smith & Nephew, receives stock options from Imagen, and receives royalties from CoorsTek, unrelated to this study. He is currently the Principal Investigator on Department of Defense–funded randomized controlled trial on the same topic. M. Joshi has received payment for consultancy and development of educational presentations from Pfizer, Forest, and Atox. Her institution has current grants from Atox. The remaining authors report no conflict of interest.

Comment in

References

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