The Use of Vancomycin Powder in Tibial Plateau Fractures at Lower Risk of Infection.

Autor:	Zingas N; Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD; and., Hannan ZD; Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD; and., Healey KM; Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD; and., McKibben NS; Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD; and., Burke CE; Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD; and., McKegg PC; Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD; and., Ghulam QM; Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD; and., O'Hara NN; Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD; and., Joshi M; Department of Medicine, Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, MD., Dubina A; Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD; and., O'Toole RV; Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD; and.
Jazyk:	angličtina
Zdroj:	Journal of orthopaedic trauma [J Orthop Trauma] 2023 Jun 01; Vol. 37 (6), pp. 282-286.
DOI:	10.1097/BOT.0000000000002555
Abstrakt:	Objective: To determine the effectiveness of vancomycin powder in preventing infection after plate and screw fixation of tibial plateau fractures considered at low risk of infection. Design: Retrospective cohort study. Setting: Single, Level I trauma center. Patients/participants: This study included 459 patients with tibial plateau fractures (OTA/AO 41-B/C) who underwent open reduction and internal fixation from 2006 to 2018 and were considered at low risk of infection based on not meeting the "high risk" definition of the VANCO trial. Intervention: Vancomycin powder administration on wound closure at the time of definitive fixation. Main Outcome Measurements: Deep surgical site infection with at least 1 gram-positive bacteria culture. Results: Vancomycin powder administration was associated with reduction in gram-positive infection from 4% to 0% (odds ratio, 0.12; 95% confidence interval, 0.04-0.32; P < 0.01). No significant effect was reported in gram-negative only infections, which were observed in 0.3% in the control group, compared with 0.9% in the intervention group (odds ratio, 2.71; 95% confidence interval, 0.11-69; P = 0.54). Methicillin-resistant Staphylococcus aureus was the most common organism isolated in the control group, growing in 9 of 18 infections (50%). Conclusions: Among patients with low-risk tibial plateau fractures, vancomycin powder at the time of definitive fixation showed a reduction in the incidence of gram-positive deep surgical site infection. The observed relative effect was relatively larger than that observed in a previous randomized trial on high-risk fractures. These data might support broadening the indication for use of vancomycin powder to include tibial plateau fractures at low risk of infection. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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