Hovis James Paul, Montalvo Ryan, Marinos Dimitrius, Joshi Manjari, Shirtliff Mark E, OʼToole Robert V, Manson Theodore T
Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD.
J Orthop Trauma. 2018 May;32(5):263-268. doi: 10.1097/BOT.0000000000001136.
To evaluate the effectiveness of intraoperative vancomycin powder in prevention of surgical site infection and biofilm formation on implants in a contaminated animal fixation model.
We created a rabbit surgical model including fixation implants at a tibial surgical site seeded with methicillin-resistant Staphylococcus aureus. Our study cohort included 18 rabbits. Nine received vancomycin powder at the surgical site, and the other 9 did not. Serum vancomycin levels were measured at scheduled time points over 24 hours. Bone infection and implant biofilm formation were determined based on the number of colony-forming units present 2 weeks after surgery. Radiography, histology, and electron microscopy aided in evaluation.
No bone infection or implant colonization occurred in the vancomycin powder group. Six bone infections and 6 implant biofilm formations (67%; 95% confidence interval, 45%-88%) occurred in the group that did not receive vancomycin powder (P = 0.009). Serum vancomycin levels were detectable at minimal levels at 1 and 6 hours only. Pathological changes occurred in the specimens that were positive for infection.
Intraoperative vancomycin powder application at the time of fixation decreases risk for bone infection and biofilm formation on implants in a rabbit model, with minimal increase in serum vancomycin levels. The results are encouraging and support the rationale for a clinical trial investigating the use of local vancomycin powder to reduce the rate of surgical site infections.
Infection is a common complication of surgery, especially with implants. Simple methods to prevent or decrease the occurrence of infection would benefit the patient and the health care system.
在污染的动物固定模型中，评估术中使用万古霉素粉末预防手术部位感染及植入物生物膜形成的有效性。
我们建立了一个兔手术模型，在胫骨手术部位植入固定植入物，并接种耐甲氧西林金黄色葡萄球菌。我们的研究队列包括18只兔子。9只在手术部位接受万古霉素粉末，另外9只未接受。在24小时内的预定时间点测量血清万古霉素水平。术后2周根据菌落形成单位数量确定骨感染和植入物生物膜形成情况。通过放射学、组织学和电子显微镜辅助评估。
万古霉素粉末组未发生骨感染或植入物定植。未接受万古霉素粉末的组发生了6例骨感染和6例植入物生物膜形成（67%；95%置信区间，45%-88%）（P = 0.009）。仅在1小时和6小时可检测到最低水平的血清万古霉素。感染阳性的标本出现了病理变化。
在兔模型中，固定时术中应用万古霉素粉末可降低骨感染风险及植入物生物膜形成，血清万古霉素水平仅有轻微升高。结果令人鼓舞，支持开展一项关于使用局部万古霉素粉末降低手术部位感染率的临床试验的理论依据。
感染是手术常见的并发症，尤其是植入物相关手术。预防或减少感染发生率的简单方法将使患者和医疗保健系统受益。
