Early application of topical antibiotic powder in open-fracture wounds: A strategy to prevent biofilm formation and infections.

Autor:	Burbank KM; US Army Institute of Surgical Research., Schauer SG; US Army Institute of Surgical Research.; Brooke Army Medical Center, JBSA Fort Sam Houston.; 59th Medical Wing, JBSA Lackland, TX.; Uniformed Services University of the Health Sciences, Bethesda, MD.; Department of Emergency Medicine, University of Texas Health Sciences Center at San Antonio, San Antonio, TX., De Lorenzo RA; Department of Emergency Medicine, University of Texas Health Sciences Center at San Antonio, San Antonio, TX., Wenke JC; US Army Institute of Surgical Research.
Jazyk:	angličtina
Zdroj:	OTA international : the open access journal of orthopaedic trauma [OTA Int] 2020 Oct 12; Vol. 3 (4), pp. e091. Date of Electronic Publication: 2020 Oct 12 (Print Publication: 2020).
DOI:	10.1097/OI9.0000000000000091
Abstrakt:	Despite meticulous surgical care and systemic antibiotics, open fracture wounds have high rates of infection leading to increased morbidity. To reduce infection rates, orthopaedic surgeons may administer local antibiotics using various carriers that may be ineffective due to poor antibiotic release from carriers, subsequent surgery to remove nondegradable carriers, and mismatch between release kinetics and material degradation. Biofilms form rapidly as bacteria that are within the wound multiply quickly and transform from the antibiotic-susceptible planktonic phenotype to the antibiotic-tolerant biofilm phenotype. This tolerance to antibiotics can occur within hours. Currently, local antibiotics are placed in the wounds using a carrier such as polymethylmethacrylate beads; however, this occurs after surgical debridement that can be hours to even a day after initial injury allowing bacteria enough time to form a biofilm that makes the antibiotic containing polymethylmethacrylate beads less effective. In contrast, emerging practices in elective surgical procedures, such as spine fusion, place antibiotic powder (e.g. vancomycin) in the wound at the time of closure. This has been shown to be extremely effective, presumably because of the very small-time period between potential contamination and local antibiotic application. There is evidence that suggests that the ineffectiveness of local antibiotic use in open fractures is primarily due to the delay in application of local antibiotics from the time of injury and propose a concept of topical antibiotic powder application in the prehospital or emergency department setting. Competing Interests: The authors have no conflicts of interest to disclose. (Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Orthopaedic Trauma Association.)
Databáze:	MEDLINE
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