Topically Applied Vancomycin Powder Reduces the Rate of Surgical Site Infection in Diabetic Patients Undergoing Foot and Ankle Surgery

Abstract

Background The purpose of this study was to evaluate the efficacy of topically applied vancomycin powder in reducing the rate of surgical site infections (SSIs) in patients with diabetes mellitus (DM) undergoing foot and ankle surgery. Methods Eighty-one patients with DM who underwent reconstructive surgery of a foot and/or ankle deformity and/or trauma and who received topically applied vancomycin were matched to 81 patients with DM who did not receive topically applied vancomycin. The mean age was 60.6 years in the vancomycin group and 59.4 years in the control group (P < .05). The 2 groups were similar with regard to gender, body mass index, duration of DM, short-term and longer term glycemic control, and length of surgery. Results The overall likelihood of SSI was decreased by 73% in patients who received topically applied vancomycin (odds ratio [OR], 0.267; 95% CI, 0.089–0.803; P = .0188). The rate of superficial infection was not significantly different between the 2 groups (OR, 0.400; 95% CI, 0.078–2.062; P = .2734); however, deep infections were 80% less likely in patients who received vancomycin powder (OR, 0.200; 95% CI, 0.044–0.913; P = .0377). Conclusion High-risk diabetic patients undergoing foot and ankle surgery were notably less likely to develop an SSI with the use of topically applied vancomycin powder in the surgical wound, particularly with regard to deep infections. Topically applied vancomycin was associated with a very low rate of complications and was inexpensive ($5 per 1000 mg). Based on this study, foot and ankle surgeons may consider applying 500 to 1000 mg of vancomycin powder prior to skin closure in diabetic patients who are not allergic to vancomycin. Level of Evidence Level III, retrospective case control series.

Local Intra-wound Administration of Powdered Antibiotics in Orthopaedic Surgery

“…72 There was a statistically significant reduction in deep surgical site infection of 73%, but no significant reduction in superficial infections.…”

Exploring Penicillin G as an Intrawound Antibiotic Powder for Prevention of Postoperative Shoulder Infections: Does It Exhibit In Vitro Chondrotoxicity?

“…Previous studies have investigated the use of topical vancomycin, gentamicin, and tobramycin for a range of orthopedic surgical indications. Vancomycin is the most commonly utilized local antibiotic in powder form within orthopedic surgery and has been the source of multiple previous studies on prevention of SSIs . Shaw et al evaluated the toxicity of vancomycin on osteochondral samples extracted from porcine stifle joints.…”

“…Vancomycin is the most commonly utilized local antibiotic in powder form within orthopedic surgery and has been the source of multiple previous studies on prevention of SSIs. 32,33,47,48 Shaw et al 42 evaluated the toxicity of vancomycin on osteochondral samples extracted from porcine stifle joints. They utilized a live/dead staining and compared varying concentrations of vancomycin to a control saline sample.…”

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 .…”