Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD; and.
Department of Medicine, Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, MD.
J Orthop Trauma. 2023 Jun 1;37(6):282-286. doi: 10.1097/BOT.0000000000002555.
To determine the effectiveness of vancomycin powder in preventing infection after plate and screw fixation of tibial plateau fractures considered at low risk of infection.
Retrospective cohort study.
Single, Level I trauma center.
PATIENTS/PARTICIPANTS: This study included 459 patients with tibial plateau fractures (OTA/AO 41-B/C) who underwent open reduction and internal fixation from 2006 to 2018 and were considered at low risk of infection based on not meeting the "high risk" definition of the VANCO trial.
Vancomycin powder administration on wound closure at the time of definitive fixation.
Deep surgical site infection with at least 1 gram-positive bacteria culture.
Vancomycin powder administration was associated with reduction in gram-positive infection from 4% to 0% (odds ratio, 0.12; 95% confidence interval, 0.04-0.32; P < 0.01). No significant effect was reported in gram-negative only infections, which were observed in 0.3% in the control group, compared with 0.9% in the intervention group (odds ratio, 2.71; 95% confidence interval, 0.11-69; P = 0.54). Methicillin-resistant Staphylococcus aureus was the most common organism isolated in the control group, growing in 9 of 18 infections (50%).
Among patients with low-risk tibial plateau fractures, vancomycin powder at the time of definitive fixation showed a reduction in the incidence of gram-positive deep surgical site infection. The observed relative effect was relatively larger than that observed in a previous randomized trial on high-risk fractures. These data might support broadening the indication for use of vancomycin powder to include tibial plateau fractures at low risk of infection.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
确定在低感染风险的胫骨平台骨折患者中使用万古霉素粉末预防术后感染的效果。
回顾性队列研究。
单一级创伤中心。
患者/参与者：本研究纳入了 2006 年至 2018 年间接受切开复位内固定术治疗的 459 例胫骨平台骨折患者（OTA/AO 41-B/C），根据 VANCO 试验的“高风险”定义，这些患者被认为感染风险较低。
在确定性固定时关闭伤口时使用万古霉素粉末。
至少有 1 种革兰阳性细菌培养阳性的深部手术部位感染。
万古霉素粉末的使用与革兰阳性感染率从 4%降至 0%相关（优势比，0.12；95%置信区间，0.04-0.32；P < 0.01）。但在仅为革兰氏阴性感染中未见明显效果，对照组为 0.3%，而干预组为 0.9%（优势比，2.71；95%置信区间，0.11-69；P = 0.54）。耐甲氧西林金黄色葡萄球菌是对照组中最常见的分离菌，在 18 例感染中生长 9 例（50%）。
在低风险胫骨平台骨折患者中，在确定性固定时使用万古霉素粉末可降低革兰阳性深部手术部位感染的发生率。观察到的相对效果大于之前高风险骨折的随机试验观察到的效果。这些数据可能支持将万古霉素粉末的使用指征扩大到低感染风险的胫骨平台骨折。
治疗性 III 级。有关证据水平的完整描述，请参见作者说明。
