Perspective from Cody C. Green, MD
Disclosures: O’Toole reports he receives grants from the U.S. Department of Defense Congressionally Directed Medical Research Program; personal fees from Smith & Nephew, Lincotek and Zimmer; stock options from Imagen; and royalties from Lincotek.
May 24, 2021
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Vancomycin powder may reduce gram-positive surgical site infection after fracture fixation

Perspective from Cody C. Green, MD
Disclosures: O’Toole reports he receives grants from the U.S. Department of Defense Congressionally Directed Medical Research Program; personal fees from Smith & Nephew, Lincotek and Zimmer; stock options from Imagen; and royalties from Lincotek.
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Use of intrawound vancomycin powder during fracture fixation of tibial articular fractures may reduce the risk of gram-positive deep surgical site infections among patients at high risk for infection, according to published results.

Robert V. O’Toole, MD, and colleagues in the Major Extremity Trauma Research Consortium randomly assigned 980 patients with either a tibial plateau or pilon fracture who were at high risk for infection to undergo a standard infection prevention protocol with (n=481) or without (n=499) 1,000 mg of intrawound vancomycin powder during plate and screw fixation. Researchers considered deep surgical site infection (SSI) within 182 days of definitive fracture fixation as the primary outcome, while secondary outcomes included superficial SSI, nonunion and wound dehiscence. Researchers used a post hoc comparison to assess the treatment effect on gram-positive and gram-negative-only infections.

Results showed 29 patients in the treatment group and 46 patients in the control group experienced deep SSI within 182 days. Researchers found a time-to-event estimated probability of deep infection by 182 days of 6.4% and 9.8% in the treatment and control groups, respectively. Post hoc analysis showed vancomycin powder resulted in a reduction of gram-positive infections, according to results.

“The study is important because, even though the use of topical vancomycin powder has grown more popular in orthopedic trauma and other areas of orthopedics, this is the first large, randomized trial to support this practice,” O’Toole told Healio Orthopedics. “The results support the biologic rationale in that the effect was only observed in bacteria that are sensitive to vancomycin and not in other types of bacteria. We believe that topical vancomycin powder is a promising new technology as it is low cost, appears to have little risk of systemic complication and helps address the devastating issue of surgical site infection that has important consequences both to individual patients and society in a broader sense.”