Owen Matthew T, Keener Emily M, Hyde Zane B, Crabtree Reaves M, Hudson Parke W, Griffin Russell L, Lowe Jason A
*University of Alabama at Birmingham, Birmingham, AL; and †University of Arizona Phoenix.
J Orthop Trauma. 2017 Nov;31(11):589-594. doi: 10.1097/BOT.0000000000000941.
To determine if topical vancomycin and tobramycin powder reduces the incidence of surgical site infection after pelvic ring and acetabulum fracture surgery.
Retrospective cohort study.
University of Alabama at Birmingham, Academic Level I Trauma Center.
PATIENTS/PARTICIPANTS: Two hundred nineteen patients (140 meeting inclusion criteria) with pelvic and acetabular fractures who underwent open reduction and internal fixation from March 2012 to November 2013.
One gram vancomycin and 1.2 g tobramycin powder applied deep in the surgical wound of the treatment group.
Postoperative infection rate.
One hundred forty patients were included. Control group (n = 69) and treatment group (n = 71) were similar for sex, age, ethnicity, and body mass index. There was no difference between groups with regards to renal function postoperative day 2 (P = 0.24). The risk of infection was 14.5% and 4.2% (P = 0.04) for the control and treatment groups, respectively. No significant effect of antibiotic treatment was observed overall after adjusting for EBL (odds ratio 0.20, 95% confidence interval, 0.02-1.06). Of note, a nonsignificant 71% increase was observed among those with ≥1 L EBL (odds ratio 1.71, 95% confidence interval, 0.02-147.02).
Topical antibiotics possibly reduce the incidence of surgical site infection after open pelvic and acetabulum fixation without increasing risk of renal impairment. The protective effect of topical antibiotics may be limited to patients with minimal intraoperative blood loss.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
确定局部应用万古霉素和妥布霉素粉末是否能降低骨盆环和髋臼骨折手术后手术部位感染的发生率。
回顾性队列研究。
阿拉巴马大学伯明翰分校一级学术创伤中心。
患者/参与者：2012年3月至2013年11月期间接受切开复位内固定术的219例骨盆和髋臼骨折患者（140例符合纳入标准）。
治疗组在手术伤口深部应用1克万古霉素和1.2克妥布霉素粉末。
术后感染率。
纳入140例患者。对照组（n = 69）和治疗组（n = 71）在性别、年龄、种族和体重指数方面相似。术后第2天两组肾功能无差异（P = 0.24）。对照组和治疗组的感染风险分别为14.5%和4.2%（P = 0.04）。调整估计失血量（EBL）后，总体未观察到抗生素治疗的显著效果（优势比0.20，95%置信区间，0.02 - 1.06）。值得注意的是，估计失血量≥1升的患者中观察到非显著的71%的增加（优势比1.71，95%置信区间，0.02 - 147.02）。
局部应用抗生素可能降低开放性骨盆和髋臼固定术后手术部位感染的发生率，且不增加肾功能损害风险。局部应用抗生素的保护作用可能仅限于术中失血极少的患者。
治疗性三级证据。有关证据水平的完整描述，请参阅作者指南。
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