Administration of vancomycin/tobramycin local antibiotic powder (LAP) after open treatment of fractures resulted in an 8.3% reduction in deep surgical site infections (SSIs) compared with no LAP procedures.
Evidence Rating Level: 2 (Good)
Conflicting data exist regarding LAP effectiveness in reducing SSIs in orthopedic surgery. While the VANCO trial showed no significant reduction in deep SSIs with vancomycin LAP, post hoc analysis suggested a decrease in gram-positive infections offset by gram-negative ones. To address this, the senior author began routinely using vancomycin and tobramycin LAP in high infection risk cases, but by 2020, found no difference in SSI rates (13% vs. 10%; P = 0.4), prompting LAP cessation. This study aimed to assess SSI rates post-LAP cessation and compare LAP and non-LAP groups using propensity-matching to control for selection bias. Vancomycin and tobramycin LAP was applied in 36.7% (n = 114) of procedures before stopping its use, after which 342 procedures were performed without LAP. Prematch analysis of procedures demonstrated that the LAP use was associated with higher BMI (MD 1.2, 95% CI, 0.09–2.4; P = 0.03), external fixation (PD 8.5%, 95% CI, 1.6%–16.2%; P = 0.005), longer operative times (MD 56.0 minutes, 95% CI, 39.0–74.0; P < 0.0001), and greater estimated blood loss (MD 70.0, 95% CI, 50.0–100.0; P < 0.0001), compared with procedures that did not receive LAP. After 1:1 propensity matching to control for the above differences there were no observed differences in patient, injury, or operative characteristics between groups. Following matching, LAP procedures showed no difference in superficial SSIs and were less likely to have deep SSIs (PD −8.3%, 95% CI: −16.2% to −0.2%; P = 0.04). Overall, these findings suggest that vancomycin and tobramycin LAP reduced deep SSI rates after open fracture treatment, supporting LAP use in high-infection
Click to read the study in the Journal of Orthopaedic Trauma
Image: PD
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