Iodine povacrylex may reduce infection in closed fractures vs. chlorhexidine gluconate
Click Here to Manage Email Alerts
Key takeaways:
- The iodine povacrylex group had reduced risks for surgical site infection after closed fracture vs. those treated with chlorhexidine gluconate.
- There was no difference between groups for unplanned reoperations.
SEATTLE — Compared with a chlorhexidine gluconate solution, data showed iodine povacrylex may reduce the risk of surgical site infection in patients with closed fractures of the lower extremity or pelvis treated with surgical fixation.
“The PREPARE-Closed trial found that iodine povacrylex in alcohol reduced the odds of infection by 26%,” Sheila Sprague, PhD, said in her presentation at the Orthopaedic Trauma Association Annual Meeting. “Water-insoluble delivery may provide the mechanism for the treatment effect that we observed.”
Sprague and colleagues randomly assigned 23 hospitals in the U.S. and Canada to use either an iodine povacrylex or chlorhexidine gluconate antiseptic solution during surgical fixation of patients with closed fractures of the lower extremity or pelvis (n=6,477; mean age, 54 years).
“In this type of trial, the clusters were randomized once to the solution to begin with and then they crossed over to the second solution every 2 months,” Sprague said. “We selected 2 months to account for seasonal variation and potential changes in infection prevention procedures. Our protocol mandated that the randomized solution had to be the last solution used prior to skin incision, and that it had to be used for all subsequent fracture surgeries.”
Researchers considered surgical site infection defined by CDC criteria as the primary outcome measure and unplanned reoperation within 1 year as the secondary outcome measure.
Sprague said patients treated with iodine povacrylex had a surgical site infection rate of 2.4% vs. 3.3% in patients treated with chlorhexidine gluconate. She also said a comparison of the two groups showed no differences in unplanned reoperation rates at 1 year.
“This robust trial has the potential to lead to a practice change that [could] prevent thousands of infections each year,” Sprague said.
Collapse
Sprague S, et al. Paper 88. Presented at: Orthopaedic Trauma Association Annual Meeting; Oct. 18-21, 2023; Seattle.
Read more about
Click Here to Manage Email Alerts