Intrasite Antibiotic Powder for the Prevention of Surgical Site Infection in Extremity Surgery: A Systematic Review

Abstract

Introduction: Although the role of intrasite antibiotic powder in preventing surgical site infections (SSIs) has been extensively explored in spinal surgery, it remains underevaluated in the other orthopaedic subspecialties. This systematic review examines the utilization of intrawound antibiotic powder as a prophylactic measure against SSIs in orthopaedic procedures. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, electronic searches were conducted on Ovid MEDLINE, and PubMed. Only English language, nonspine clinical studies published before May 2018 were included. Results: The initial search identified 179 individual citations, and 11 studies met the eligibility criteria. All included studies were level III retrospective studies. Represented subspecialties included total joint arthroplasty, upper extremity, foot and ankle, and trauma. Eight studies demonstrated a statistically significant decrease in SSIs with the use of intrasite antibiotic powder. Discussion: There are no current guidelines for the use of intrasite antibiotic powder for the prevention of SSIs in orthopaedic procedures. Despite the lack of high-quality evidence available in the literature, published smaller studies do suggest a significant protective effect. However, recommendations with regard to this technique after common orthopaedic procedures cannot yet be made.

Supratherapeutic Antibiotic Levels and Acute Kidney Injury from Absorption of Topical Antibiotics

“…The use of topical antibiotics has grown among trauma surgeons because of the potential for high local concentrations without systemic complications, along with less reliance on local blood supply that may be damaged in extremity trauma. Multiple previous studies have suggested that systemic absorption of topical antibiotics is minimal 10,12,14 . Ghobrial et al .…”

“…The use of topical antibiotics has grown among trauma surgeons because of the potential for high local concentrations without systemic complications, along with less reliance on local blood supply that may be damaged in extremity trauma. Multiple previous studies have suggested that systemic absorption of topical antibiotics is minimal 10,12,14 . Ghobrial et al examined the adverse events associated with intrawound vancomycin in lumbar spinal surgery in 6,701 patients and found only a single case of systemic absorption, resulting in supratherapeutic vancomycin exposure 11 .…”

“…T he use of topical antibiotics during orthopaedic trauma surgery remains somewhat controversial. Some studies have found a significant reduction in the rate of SSI of up to 40% with the use of intrawound antibiotics 10,14 . Additional benefits have been shown to include decreased severity of heterotopic ossification in combat lower extremity amputations and increased bone regeneration 15,16 .…”

“…The role of intrawound antibiotics in preventing SSIs has been explored in spinal surgery, with very few cases demonstrating systemic absorption or adverse outcomes [5][6][7] . However, its use remains somewhat controversial in other orthopaedic subspecialties, with mixed results on its efficacy [8][9][10] . Despite this, topical vancomycin continues to gain popularity among trauma surgeons.…”

Prophylactic Topical Antibiotics in Fracture Repair and Spinal Fusion

“…Previous systematic reviews have examined the effect of intrawound antibiotics in either instrumented spinal procedures or open limb fractures [9,[12][13][14][15][16]. Because both fields share a high risk of infection and the objective of achieving bony union, which may be affected by local antibiotics, we believe there is value in reporting pooled outcomes of local antibiotics comprehensively from both specialties.…”