Intrawound application of vancomycin reduces the proportion of fracture-related infections in high-risk tibial plateau fractures

Wang, Hanzhou; Liu, Yang; Shi, Zongxin; Wang, Dong; Zhang, Hui; Diao, Shuo; Xu, Xiaopei; Waheed, Muhammad Zeeshan; Lu, Tianchao; Zhou, Junlin

doi:10.1016/j.injury.2023.01.055

Cited by 5 publications

(4 citation statements)

References 27 publications

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“…Emerging evidence suggests that topical vancomycin reduces SSI mainly in spine surgeries and tibial fractures [ 9 , 11 , 13 , 14 ]. However, conclusive evidence is limited due to conflicting results and the lack of level-I studies.…”

Section: Discussionmentioning

confidence: 99%

“…A series of recent studies have investigated the efficacy of topical vancomycin in preventing SSI, offering encouraging results related to tibial plateau fractures [ 13 ], spine surgeries [ 17 ], and pelvic and acetabular surgeries [ 10 ]. In contrast, our study assessed infection presence between groups up to three months in closed ankle fractures with no statistically significant differences observed in the evaluations conducted at two weeks, four weeks, and three months.…”

Section: Discussionmentioning

confidence: 99%

“…An early study also showed an elevated risk of gram-negative and polymicrobial infections associated with the use of vancomycin powder in spine surgeries [ 14 ]. Wang H et al reported in a similar study a higher incidence of infections related to tibial plateau fractures caused by Gram-positive microorganisms in the control group (12/128 subjects) compared to the group where vancomycin was applied (1/105 subjects) [ 13 ]. These findings align with the results of our study, where the primary causative agents of SSI were S. aureus (Gram-positive) and Acinetobacter baumannii (Gram-negative) in the group that utilized vancomycin.…”

Section: Discussionmentioning

confidence: 99%

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Effect of Topical Vancomycin on Surgical Site Infections in Ankle Fractures: A Randomized, Double-Blind, Controlled Trial

Acosta-Olivo,

Hernández-Alejo,

Rangel-Alanís

et al. 2024

Cureus

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Background Applying topical vancomycin has shown a decrease in the likelihood of surgical site infections (SSIs) in surgeries linked to a heightened risk of severe and resistant infections. Nevertheless, the effectiveness of this prophylactic approach has not been assessed in open ankle surgeries with internal fixation. Objective This study aimed to assess whether topical vancomycin diminishes the risk of SSI in patients with ankle fractures undergoing open reduction with internal fixation. Methods A randomized, controlled, double-blind clinical trial was carried out. Patients were divided into two groups in a 1:1 ratio. The control group received the standard prophylactic treatment with IV cephalothin 1 g, while the intervention group was administered topical vancomycin (1 g) in addition to the standard prophylactic treatment. The main outcomes were the SSI rates at 14 days, 28 days, and three months post-surgery, based on relevant clinical signs and laboratory tests. Results One hundred thirty-two patients were randomized (51.2% female), with 66 subjects included in each intervention arm. A total of 97.7% of them completed the study. Both groups were homogeneous in baseline characteristics. There were two SSIs in both the vancomycin group (3.3%) and the control group (3.5%), with no statistical differences (p = 0.945). The microorganisms isolated as causal agents were Staphylococcus aureus and Acinetobacter baumannii . By the three-month follow-up, no infections were noted in both intervention groups. Conclusion These results indicate that the topical administration of vancomycin may not represent an advantage in preventing SSI in ankle fractures requiring open reduction with internal fixation at the three-month postoperative stage.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Effect of Topical Vancomycin on Surgical Site Infections in Ankle Fractures: A Randomized, Double-Blind, Controlled Trial

Acosta-Olivo,

Hernández-Alejo,

Rangel-Alanís

et al. 2024

Cureus

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“…Meanwhile, other viable options for local application of antibiotics exists in surgical practice. In recent years, application of pure antibiotic powder such as vancomycin has been proven to reduce infection risk in fracture care (Marchand et al, 2023;Wang et al, 2023). In addition, collagen sponges soaked with antibiotics are another option to apply antibiotics to the surgical site (Chaudhary et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

The antibiotic bead pouch – a useful technique for temporary soft tissue coverage, infection prevention and therapy in trauma surgery

Rupp

Walter

Szymski

et al. 2023

J. Bone Joint Infect.

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Abstract. Soft tissue defects resulting from trauma and musculoskeletal infections can complicate surgical treatment. Appropriate temporary coverage of these defects is essential to achieve the best outcomes for necessary plastic soft tissue defect reconstruction. The antibiotic bead pouch technique is a reasonable surgical approach for managing temporary soft tissue defects following adequate surgical debridement. This technique involves the use of small diameter antibiotic-loaded bone cement beads to fill the dead space created by debridement. By applying antibiotics to the bone cement and covering the beads with an artificial skin graft, high local dosages of antibiotics can be achieved, resulting in the creation of a sterile wound that offers the best starting position for soft tissue and bone defect reconstruction. This narrative review describes the rationale for using this technique, including its advantages and disadvantages, as well as pearls and pitfalls associated with its use in daily practice. In addition, the article provides a comprehensive overview of the literature that has been published since the technique was introduced in surgical practice.

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Predictive factors for infection after osteosynthesis of tibial plateau fractures: a retrospective study of 314 patients

Olivieri,

Koch,

Laso

et al. 2024

Eur J Orthop Surg Traumatol

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Intrawound application of vancomycin reduces the proportion of fracture-related infections in high-risk tibial plateau fractures

Cited by 5 publications

References 27 publications

Effect of Topical Vancomycin on Surgical Site Infections in Ankle Fractures: A Randomized, Double-Blind, Controlled Trial

Effect of Topical Vancomycin on Surgical Site Infections in Ankle Fractures: A Randomized, Double-Blind, Controlled Trial

The antibiotic bead pouch – a useful technique for temporary soft tissue coverage, infection prevention and therapy in trauma surgery

Predictive factors for infection after osteosynthesis of tibial plateau fractures: a retrospective study of 314 patients

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