Shiels Stefanie M, Sgromolo Nicole M, Wenke Joseph C
Orthopaedic Trauma Research Department, U.S. Army Institute of Surgical Research, San Antonio, Texas, USA.
Department of Orthopaedic Surgery, Brooke Army Medical Center, San Antonio, Texas, USA.
Bone Joint Res. 2021 Feb;10(2):149-155. doi: 10.1302/2046-3758.102.BJR-2020-0171.R1.
High-energy injuries can result in multiple complications, the most prevalent being infection. Vancomycin powder has been used with increasing frequency in orthopaedic trauma given its success in reducing infection following spine surgery. Additionally, large, traumatic injuries require wound coverage and management by dressings such as negative pressure wound therapy (NPWT). NPWT has been shown to decrease the ability of antibiotic cement beads to reduce infection, but its effect on antibiotic powder is not known. The goal of this study was to determine if NPWT reduces the efficacy of topically applied antibiotic powder.
Complex musculoskeletal wounds were created in goats and inoculated with a strain of modified to emit light. Six hours after contaminating the wounds, imaging, irrigation, and debridement and treatment application were performed. Animals received either vancomycin powder with a wound pouch dressing or vancomycin powder with NPWT.
There were no differences in eradication of bacteria when vancomycin powder was used in combination with NPWT (4.5% of baseline) compared to vancomycin powder with a wound pouch dressing (1.7% of baseline) (p = 0.986), even though approximately 50% of the vancomycin was recovered in the NPWT exudate canister.
The antimicrobial efficacy of the vancomycin powder was not diminished by the application of NPWT. These topical and locally applied therapies are potentially effective tools that can provide quick, simple treatments to prevent infection while providing coverage. By reducing the occurrence of infection, the recovery is shortened, leading to an overall improvement in quality of life. Cite this article: 2021;10(2):149-155.
高能损伤可导致多种并发症，其中最常见的是感染。万古霉素粉末因其在脊柱手术后成功降低感染率，在骨科创伤中的使用频率越来越高。此外，大面积创伤性损伤需要通过负压伤口治疗（NPWT）等敷料进行伤口覆盖和处理。已证明NPWT会降低抗生素骨水泥珠减少感染的能力，但其对抗生素粉末的影响尚不清楚。本研究的目的是确定NPWT是否会降低局部应用抗生素粉末的疗效。
在山羊身上制造复杂的肌肉骨骼伤口，并接种一种经过改造能发光的菌株。伤口污染6小时后，进行成像、冲洗、清创和治疗应用。动物接受使用伤口袋敷料的万古霉素粉末或使用NPWT的万古霉素粉末。
与使用伤口袋敷料的万古霉素粉末（基线的1.7%）相比，万古霉素粉末与NPWT联合使用时细菌清除率无差异（基线的4.5%）（p = 0.986），尽管约50%的万古霉素在NPWT渗出液罐中被回收。
NPWT的应用并未降低万古霉素粉末的抗菌疗效。这些局部和局部应用的疗法可能是有效的工具，可以提供快速、简单的治疗以预防感染，同时提供覆盖。通过减少感染的发生，恢复时间缩短，从而总体提高生活质量。引用本文：2021;10(2):149-155。
