Immunology and Molecular Microbiology, Texas Tech University Health Sciences Center, Lubbock, TX.
Institute for Health Policy, University of Texas Health Science Center School of Public Health, Houston, TX.
J Orthop Trauma. 2018 Oct;32(10):538-541. doi: 10.1097/BOT.0000000000001259.
To compare the effectiveness of both vancomycin powder and antibiotic bead placement to irrigation and debridement alone in prevention of infection in a contaminated open fracture model in rats.
In a previously described model of contaminated open fractures, 45 rats had simulated open fractures created, stabilized, and contaminated with Staphylococcus aureus. They were then treated 6 hours later with 3 interventions: irrigation and debridement alone (control group) or in combination with placement of polymethyl methacrylate beads containing vancomycin and tobramycin powders (antibiotic bead group) or placement of 10 mg of intrawound vancomycin powder (powder group). Rats were allowed to recover and then killed 14 days later for harvest of femurs and plates. Femurs and plates were both incubated overnight, and bacterial colonies were counted in each group for comparison.
Quantitative counts of bacteria in bone showed significantly reduced growth in both bead and powder groups when compared with control group (P < 0.0001). Quantitative counts of bacteria in plates showed significantly reduced growth in both bead and powder groups when compared with control group (P < 0.0003; 0.029). No significant differences were seen in bacterial growth between bead and powder groups for either bones (P = 0.13) or plates (P = 0.065).
When compared with irrigation and debridement alone, placement of intrawound vancomycin powder significantly decreased bacterial load in a contaminated open fracture model in rats similar to placing antibiotic beads. This may provide an additional adjuvant treatment that does not require a secondary surgery for bead removal.
比较万古霉素粉末和抗生素珠放置与单独冲洗和清创在预防大鼠污染开放性骨折模型感染中的效果。
在先前描述的污染开放性骨折模型中，45 只大鼠模拟了开放性骨折的形成、稳定和金黄色葡萄球菌污染。然后，在 6 小时后，对其进行 3 种干预措施治疗：单独冲洗和清创（对照组），或与含有万古霉素和妥布霉素粉末的聚甲基丙烯酸甲酯珠放置（抗生素珠组），或在伤口内放置 10 毫克万古霉素粉末（粉末组）。大鼠恢复后，14 天后收获股骨和钢板。股骨和钢板均孵育过夜，比较每组的细菌菌落数。
与对照组相比，骨内细菌定量计数显示珠组和粉组的细菌生长均显著减少（P<0.0001）。与对照组相比，板内细菌定量计数显示珠组和粉组的细菌生长均显著减少（P<0.0003；0.029）。在骨（P=0.13）或板（P=0.065）中，珠组和粉组之间的细菌生长均无显著差异。
与单独冲洗和清创相比，在污染的开放性骨折模型中，将伤口内的万古霉素粉末放置可显著降低大鼠的细菌负荷，效果类似于放置抗生素珠。这可能提供了一种不需要进行二次手术去除珠的额外辅助治疗方法。
