Qadir Rabah, Costales Timothy, Coale Max, Mulliken Alexandra, Zerhusen Timothy, Joshi Manjari, Castillo Renan C, Carlini Anthony R, O'Toole Robert V
Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD.
Division of Infectious Disease, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD; and.
J Orthop Trauma. 2021 Jan 1;35(1):23-28. doi: 10.1097/BOT.0000000000001863.
To determine if the use of intrawound vancomycin powder reduces surgical-site infection after open reduction and internal fixation of bicondylar tibial plateau, tibial pilon, and calcaneus fractures.
Retrospective analysis.
Level I trauma center.
All fractures operatively treated from January 2011 to February 2015 were reviewed; 583 high-risk fractures were included, of which 35 received topical vancomycin powder. A previously published prospectively collected cohort of 235 similar high-risk fractures treated at our center from 2007 through 2010 served as a second comparison group.
Topical vancomycin powder at wound closure.
Deep surgical-site infection. Analyses used both univariate comparison of all patients and 1:2 matching analysis using both nearest neighbor and propensity-based matching.
Compared with a control group of fractures treated during the same time period without vancomycin powder, the infection rate with vancomycin powder was significantly lower [0% (0/35) vs. 10.6% (58/548), P = 0.04]. Compared with our previously published historical infection rate of 13% for these injuries, vancomycin powder was also associated with significantly decreased deep surgical-site infection (0% vs. 13%, P = 0.02). These results agreed with the matched analyses, which also showed lower infection in the vancomycin powder group (0% vs. 11%-16%, P ≤ 0.05).
Vancomycin powder may play a role in lowering surgical-site infection rates after fracture fixation. A larger randomized controlled trial is needed to validate our findings.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
确定在双髁胫骨平台、胫骨 Pilon 和跟骨骨折切开复位内固定术后使用伤口内万古霉素粉剂是否能降低手术部位感染率。
回顾性分析。
一级创伤中心。
对 2011 年 1 月至 2015 年 2 月期间所有接受手术治疗的骨折患者进行了回顾；纳入了 583 例高危骨折患者，其中 35 例接受了局部万古霉素粉剂治疗。一个先前发表的前瞻性收集的队列，包括 2007 年至 2010 年在我们中心治疗的 235 例类似高危骨折患者，作为第二个对照组。
伤口闭合时局部使用万古霉素粉剂。
深部手术部位感染。分析采用了所有患者的单因素比较以及使用最近邻匹配和倾向匹配的 1:2 匹配分析。
与同期未使用万古霉素粉剂治疗的骨折对照组相比，使用万古霉素粉剂的感染率显著更低[0%（0/35）对 10.6%（58/548），P = 0.04]。与我们先前发表的这些损伤的历史感染率 13%相比，万古霉素粉剂也与深部手术部位感染显著降低相关（0%对 13%，P = 0.02）。这些结果与匹配分析一致，匹配分析也显示万古霉素粉剂组感染率更低（0%对 11%-16%，P≤0.05）。
万古霉素粉剂可能在降低骨折固定术后手术部位感染率方面发挥作用。需要进行更大规模的随机对照试验来验证我们的发现。
治疗性三级。有关证据级别的完整描述，请参阅作者指南。
Zotero 插件