Department of Orthopaedics and Rehabilitation. Oregon Health and Science University, Portland, OR; and.
Department of Medicine, Division of Infectious Diseases. University of Pittsburgh, Pittsburgh, PA.
J Orthop Trauma. 2023 Aug 1;37(8):386-392. doi: 10.1097/BOT.0000000000002595.
Evaluate the species distribution and resistance patterns of bacterial pathogens causing surgical site infection (SSI) after operative fracture repair, with and without the use of intrawound powdered antibiotic (IPA) prophylaxis during the index surgery.
Retrospective cohort study.
Academic, level 1 trauma center, 2018-2020.
PATIENTS/PARTICIPANTS: Fifty-nine deep SSIs were identified in a sample of 734 patients with 846 fractures (IPA [n = 320], control [n = 526]; open [n = 157], closed fractures [n = 689]) who underwent orthopaedic fracture care. Among SSIs, 28 (48%) patients received IPA prophylaxis and 25 (42%) of the fractures were open.
Intrawound powdered vancomycin and tobramycin.
Distribution of bacterial species and resistance patterns causing deep surgical site infections requiring operative debridement.
Zero patients developed infections caused by resistant strains of streptococci, enterococci, gram-negative enterics, Pseudomonas , or Cutibacterium species. The only resistant strains isolated were methicillin resistance (19%) and oxacillin-resistant coagulase-negative staphylococci (16%). There was no associated statistical difference in the proportion of bacterial species isolated, their resistance profiles, or rate of polymicrobial infections between the IPA and control group. Most (93%) cases using IPAs included vancomycin and tobramycin powders. There were 59 SSIs; 28 (9%) in the IPA cohort and 31 (6%) in the control cohort ( P = 0.13).
The use of local antibiotic prophylaxis resulted in no measurable increase in the proportion of infections caused by resistant bacterial pathogens after operative treatment of fractures. However, the small sample size and limited time frame of these preliminary data require continued investigation into their role as an adjunct to SSI prophylaxis.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
评估在接受手术骨折修复时使用和不使用术中伤口内粉末抗生素（IPA）预防的情况下，导致手术部位感染（SSI）的细菌病原体的物种分布和耐药模式。
回顾性队列研究。
学术性一级创伤中心，2018-2020 年。
患者/参与者：在接受骨科骨折治疗的 734 名患者 846 例骨折（IPA[n=320]，对照组[n=526]；开放性[n=157]，闭合性骨折[n=689]）中，确定了 59 例深部 SSI。在 SSI 中，28 例（48%）患者接受 IPA 预防，25 例（42%）的骨折为开放性。
伤口内万古霉素和妥布霉素粉末。
导致需要手术清创的深部手术部位感染的细菌种类和耐药模式分布。
没有患者发生对链球菌、肠球菌、革兰氏阴性肠杆菌、铜绿假单胞菌或痤疮丙酸杆菌等耐药菌株引起的感染。唯一分离出的耐药菌株是耐甲氧西林（19%）和耐甲氧西林凝固酶阴性葡萄球菌（16%）。IPA 组和对照组之间，分离的细菌种类、耐药谱或混合感染率均无统计学差异。使用 IPA 的大多数（93%）病例包括万古霉素和妥布霉素粉末。有 59 例 SSI；IPA 队列中有 28 例（9%），对照组中有 31 例（6%）（P=0.13）。
在手术治疗骨折后，使用局部抗生素预防并未导致耐药细菌病原体引起的感染比例增加。然而，这些初步数据的样本量小且时间有限，需要进一步研究其作为 SSI 预防的辅助手段的作用。
治疗性 III 级。有关证据水平的完整描述，请参阅作者说明。
