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Published on: April 30, 2014
Comparison Between Vancomycin and Gentamicin for Intraoperative Presoaking of Hamstring Graft in Primary Anterior
Deepak Bansal1, Kavin Khatri2, Anshul Dahuja3
1Orthopaedics and Traumatology, AIMC Bassi Hospital and Ludhiana Mediways Hospital, Ludhiana, IND.
Abstract:
Introduction Postoperative infection is an uncommon complication with grave consequences following anterior cruciate ligament reconstruction (ACLR). Presoaking of the hamstring graft with antibiotics results in a lower rate of infection. The purpose of the current study was to compare the efficacy of two commonly used antibiotics, vancomycin and gentamicin, in reducing infection rates following anterior cruciate ligament reconstruction. Methods The retrospective study included a total of 578 patients who underwent arthroscopic anterior cruciate ligament reconstruction between June 2015 and October 2021. The timeline was categorized as the period between June 2015 to October 2018 (Vancomycin presoaking of hamstring graft) and November 2018 to October 2021 (Gentamicin presoaking of hamstring graft). All patients were examined for the development of infection, causative organism, and treatment received. Patients with intravenous drug abuse, alcoholism, steroid use, revision cases, and a prior history of infection in the knee were excluded from the study. Fisher's exact test was used for comparison of categorical data, and Poisson regression analysis was carried out to calculate incidence rate ratios after adjusting for confounding variables. Results Presoaking of hamstring grafts with vancomycin was carried out in 224 patients, and gentamicin was used in 354 patients. In total, three patients in the vancomycin and four patients in the gentamicin groups developed an intraarticular infection, and the difference in infection rate between the two groups was not statistically significant (p=0.919). Coagulase-negative Staphylococcus aureus was isolated in four cases, Enterobacter cloacae in one, and no organism was seen in two cases. The groups were comparable in terms of age (p=0.563), smoking (p=0.84), sex (p=0.359), and operative time (p=0.09). Conclusion Presoaking of hamstring autografts with gentamicin intraoperatively is a good alternative to vancomycin in the prevention of infection following arthroscopic anterior cruciate ligament reconstruction.
Insights
Antibiotic presoaking of hamstring grafts helps prevent infection after anterior cruciate ligament reconstruction (ACLR). Both vancomycin and gentamicin showed similar, low infection rates in this study.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Prevention
- Surgical Site Infections
Background:
- Postoperative infection is a serious complication of anterior cruciate ligament reconstruction (ACLR).
- Antibiotic presoaking of hamstring grafts is a strategy to reduce ACLR infection rates.
- Comparing vancomycin and gentamicin for graft presoaking is crucial for optimizing infection control.
Purpose of the Study:
- To compare the efficacy of vancomycin versus gentamicin in preventing intraarticular infection after arthroscopic anterior cruciate ligament reconstruction.
- To evaluate infection rates and causative organisms in patients undergoing ACLR with antibiotic-soaked hamstring grafts.
Main Methods:
- Retrospective study of 578 patients undergoing arthroscopic ACLR from June 2015 to October 2021.
- Patients received either vancomycin (June 2015-Oct 2018) or gentamicin (Nov 2018-Oct 2021) for hamstring graft presoaking.
- Exclusion criteria included drug abuse, alcoholism, steroid use, revisions, and prior knee infections. Statistical analysis used Fisher's exact test and Poisson regression.
Main Results:
- Three infections occurred in 224 patients receiving vancomycin, and four infections in 354 patients receiving gentamicin.
- The difference in infection rates between vancomycin and gentamicin groups was not statistically significant (p=0.919).
- Coagulase-negative Staphylococcus aureus was the most common organism identified.
Conclusions:
- Intraoperative hamstring autograft presoaking with gentamicin is a viable alternative to vancomycin for preventing infection after arthroscopic ACLR.
- Both antibiotics demonstrate comparable effectiveness in reducing infection rates in this patient cohort.
- Further research may explore optimal antibiotic concentrations and durations for graft presoaking.
