Systematic Review and Meta-Analysis of Intrawound Vancomycin in Total Hip and Total Knee Arthroplasty: A Continued Call for a Prospective Randomized Trial

Movassaghi, Kamran; Wang, Jennifer C.; Gettleman, Brandon S.; Mayfield, Cory K.; Oakes, Daniel A.; Lieberman, Jay R.; Heckmann, Nathanael

doi:10.1016/j.arth.2022.03.047

Cited by 26 publications

(26 citation statements)

References 63 publications

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“…It is also used in fractures and traumatic injuries (O'Toole et al, 2021). More recently it has been used in primary joint arthroplasties and revisions, albeit with variable results (Movassaghi et al, 2022;Saidahmed et al, 2021). We recently showed vancomycin powder to be active against Staphylococcus epidermidis biofilms on spinal implants in vivo (Karau et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

Locally delivered antistaphylococcal lysin exebacase or CF-296 is active in methicillin-resistantStaphylococcus aureusimplant-associated osteomyelitis

Karau

Schmidt-Malan²,

Mandrekar³

et al. 2022

J. Bone Joint Infect.

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Abstract. Introduction: Staphylococcus aureus is the most common cause of orthopedic infections and can be challenging to treat, especially in the presence of a foreign body. The antistaphylococcal lysins exebacase and CF-296 have rapid bactericidal activity, a low propensity for resistance development, and synergize with some antibiotics. Methods: Rabbit implant-associated osteomyelitis was induced by drilling into the medial tibia followed by locally delivering exebacase, CF-296, or lysin carrier. A titanium screw colonized with methicillin-resistant S. aureus (MRSA) IDRL-6169 was inserted. Intravenous daptomycin or saline was administered and continued daily for 4 d. On day 5, rabbits were euthanized, and the tibiae and implants were collected for culture. Results were reported as log10 colony forming units (cfu) per gram of bone or log10 cfu per implant, and comparisons among the six groups were performed using the Wilcoxon rank sum test. Results: Based on implant and bone cultures, all treatments resulted in significantly lower bacterial counts than those of controls (P≤0.0025). Exebacase alone or with daptomycin as well as CF-296 with daptomycin were more active than daptomycin alone (P≤0.0098) or CF-296 alone (P≤0.0154) based on implant cultures. CF-296 with daptomycin was more active than either CF-296 alone (P=0.0040) or daptomycin alone (P=0.0098) based on bone cultures. Conclusion: Local delivery of either exebacase or CF-296 offers a promising complement to conventional antibiotics in implant-associated infections.

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Section: Discussionmentioning

confidence: 99%

Locally delivered antistaphylococcal lysin exebacase or CF-296 is active in methicillin-resistantStaphylococcus aureusimplant-associated osteomyelitis

Karau

Schmidt-Malan²,

Mandrekar³

et al. 2022

J. Bone Joint Infect.

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“… 9 , 10 Nevertheless, numerous investigations have demonstrated that methicillin resistance does not affect cephalosporins' effectiveness in preventing wound infections at surgical sites. 11 Research evaluating the impact of intrawound powdered vancomycin during spine surgery showed encouraging results. To further reduce the frequency of surgical site wound infections, surgeons have recently been interested in this unique preventative strategy.…”

Section: Introductionmentioning

confidence: 99%

“…The gold standard of care for surgical site wound infection prevention for many years has been the use of cefazolin and other broad‐spectrum antibiotics 9,10 . Nevertheless, numerous investigations have demonstrated that methicillin resistance does not affect cephalosporins' effectiveness in preventing wound infections at surgical sites 11 . Research evaluating the impact of intrawound powdered vancomycin during spine surgery showed encouraging results.…”

Section: Introductionmentioning

confidence: 99%

Effect of powdered vancomycin on stopping surgical site wound infections in neurosurgery: A meta‐analysis

Tian

Han

et al. 2022

International Wound Journal

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We performed a meta‐analysis to evaluate the effect of powdered vancomycin on stopping surgical site wound infections in neurosurgery. A systematic literature search up to July 2022 was performed and 24 137 subjects with neurosurgery at the baseline of the studies; 10 496 of them were using the powdered vancomycin, and 13 641 were not using the powdered vancomycin as a control. Odds ratio (OR) with 95% confidence intervals (CIs) were calculated to assess the effect of powdered vancomycin on stopping surgical site wound infections in neurosurgery using dichotomous methods with a random or fixed‐effect model. The powdered vancomycin had significantly lower surgical site wound infections after spinal surgery (OR, 0.53; 95% CI, 0.41‐0.70, P < .001), deep surgical site wound infections after spinal surgery (OR, 0.45; 95% CI, 0.35‐0.57, P < .001), superficial surgical site wound infections after spinal surgery (OR, 0.60; 95% CI, 0.43‐0.83, P = .002), and surgical site wound infections after cranial surgery (OR, 0.37; 95% CI, 0.22‐0.61, P < .001) compared to control in subjects with neurosurgery. The powdered vancomycin had significantly lower surgical site wound infections after spinal surgery, deep surgical site wound infections after spinal surgery, superficial surgical site wound infections after spinal surgery, and surgical site wound infections after cranial surgery compared to control in subjects with neurosurgery. The analysis of outcomes should be done with caution even though the low number of studies with low sample size, 3 out of the 42 studies, in the meta‐analysis, and a low number of studies in certain comparisons.

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“…In just two years, between 2020 and 2022, seven systematic reviews and/or meta-analyses have been published in international peer-reviewed orthopaedic journals, often reporting conflicting results. 38-44…”

mentioning

confidence: 99%

“…A meta-analysis by Movassaghi et al 38 included 16 studies with a total of 17,164 TJRs, reporting that the use of vancomycin powder intraoperatively may reduce the risk of PJI in primary and revision TJR without leading to systemic complications. However, 83% of the TJRs were primary TKAs (14,262 of 17,164), and 69% (9,884 primary TKAs) came from a single study in which vancomycin powder was used in combination with 0.35% povidone-iodine solution (17.5 ml in 500 ml saline).…”

mentioning

confidence: 99%

Vancomycin powder in total joint replacement

Mancino,

Gant,

Meek

et al. 2023

Bone Joint J

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Systematic Review and Meta-Analysis of Intrawound Vancomycin in Total Hip and Total Knee Arthroplasty: A Continued Call for a Prospective Randomized Trial

Cited by 26 publications

References 63 publications

Locally delivered antistaphylococcal lysin exebacase or CF-296 is active in methicillin-resistantStaphylococcus aureusimplant-associated osteomyelitis

Locally delivered antistaphylococcal lysin exebacase or CF-296 is active in methicillin-resistantStaphylococcus aureusimplant-associated osteomyelitis

Effect of powdered vancomycin on stopping surgical site wound infections in neurosurgery: A meta‐analysis

Vancomycin powder in total joint replacement

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