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Intrawound vancomycin powder may reduce SSI rate in patients with tibial plateau, pilon fractures
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ORLANDO, Fla. — Use of vancomycin powder compared with the standard of care reduced the rate of gram-positive surgical site infections in patients with tibial plateau or pilon fractures, according to a presenter at the Orthopaedic Trauma Association Annual Meeting.
Robert V. O’Toole , MD, and colleagues performed a phase 3, prospective, randomized clinical trial of 984 patients from 36 Level-1 trauma centers with tibial plateau or pilon fractures treated with either plate or screw fixation. There were 481 patients assigned to treatment with 1,000 mg of vancomycin powder placed before wound closure and 499 patients were assigned to a control group that received the standard of care. At 2 weeks, 12 weeks and 26 weeks after fixation, follow-ups were performed. Deep surgical site infection (SSI) within 6 months based on CDC criteria was the primary outcome.
Results showed the control group had a 10.3% infection rate compared with a 6.7% rate in patients who received intrawound vancomycin powder. There was no evidence that demonstrated a differential effect in pilon or tibial plateau fractures or in open or closed fractures.
Results from a pathogen analysis showed gram-negative infection did not affect the vancomycin, so the infection rate was 2.1% in the control group and 2.6% for those who received vancomycin. However, analysis of gram-positive infections showed a drop in the infection rate from 7.8% to 3.7%. Deep SSIs decreased from 10.3% to 6.7%.
“If you look at the bacteriology, the analysis that was not planned, these results are consistent with how you expect vancomycin to work biologically .... ” O’Toole said. “Overall restoration was 0.66. Our secondary analyses found no harm, no particular difference in nonunion or other issues. Our postop analysis appears to show vancomycin almost has no effect on gram-negative, but it does appear to reduce the gram-positive [infections]... ” – by Monica Jaramillo
Reference:
O’Toole RV, et al. Paper 71. Presented at: Orthopaedic Trauma Association Annual Meeting; Oct. 18-20, 2018; Orlando, Fla.
Disclosures: O’Toole reports he is a paid consultant for Smith & Nephew; is a board or committee member of the Orthopaedic Trauma Association; receives intellectual property royalties and is a paid consultant for CoorsTek and is a paid consultant for and has stock or stock options in Imagen.