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Topical Vancomycin Powder Decreases the Proportion of Staphylococcus aureus Found in Culture of Surgical Site
Rabah Qadir1, Timothy Costales1, Max Coale1
1Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD; and.
Objectives:
To determine whether patients with operatively treated fractures and surgical site infection after use of topical vancomycin powder have a lower proportion of Staphylococcus aureus infections than patients who did not receive topical vancomycin powder.
Design:
Retrospective cohort study.
Setting:
Level I trauma center.
Patients:
Treatment group: 10 of 133 patients (145 fractures) with surgical site infections who received intrawound vancomycin powder at the time of wound closure for fracture fixation. Control group: 175 patients who sustained deep surgical site infections during the same period but did not receive vancomycin powder.
Intervention:
Vancomycin powder or no vancomycin powder.
Main Outcome Measurement:
Proportion of patients' cultures positive for S. aureus.
Results:
The proportion of cultures positive for S. aureus was significantly lower in patients with surgical site infection who received vancomycin powder than in those who did not receive vancomycin powder (10% [1 of 10 patients in the treatment group] vs. 50% [87 of 175 patients in the control group]; P = 0.02). A trend was observed for a lower proportion of methicillin-resistant S. aureus (0% vs. 23%; P = 0.12).
Conclusions:
Vancomycin powder might alter the bacteriology of surgical site infections and decrease the proportion in culture of the most common organism typically present after fracture surgery infection. These findings suggest that the application of vancomycin powder might change the bacteriology of surgical site infections when they occur, regardless of the effect on overall infection rates. Although our bacteriology results are clinically and statistically significant, these findings must be confirmed in larger randomized controlled trials.
Level Of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Insights
Topical vancomycin powder use in fracture surgery patients with surgical site infections significantly reduced Staphylococcus aureus infections. This suggests vancomycin powder may alter infection bacteriology, warranting further research.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Pharmacology
Background:
- Surgical site infections (SSIs) are a complication of operative fracture treatment.
- Staphylococcus aureus is a common pathogen in SSIs following fracture fixation.
Purpose of the Study:
- To evaluate the impact of topical vancomycin powder on the proportion of Staphylococcus aureus (S. aureus) in SSIs after operative fracture treatment.
Main Methods:
- Retrospective cohort study conducted at a Level I trauma center.
- Compared SSIs in patients who received intrawound vancomycin powder versus those who did not.
- Analyzed the proportion of S. aureus in cultures from infected surgical sites.
Main Results:
- A significantly lower proportion of S. aureus was found in SSIs of patients treated with vancomycin powder (10%) compared to the control group (50%) (P = 0.02).
- A trend towards a lower proportion of methicillin-resistant S. aureus (MRSA) was observed in the vancomycin group (0% vs. 23%).
Conclusions:
- Topical vancomycin powder may alter the bacteriology of SSIs, decreasing the prevalence of S. aureus.
- These findings suggest a potential role for vancomycin powder in modifying SSI microbiology.
- Larger randomized controlled trials are needed to confirm these bacteriological findings.
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