Local Administration Of Antibiotics Research Articles

The Use of Dissolvable Synthetic Calcium Impregnated with Antibiotic in Osteoarticular Infection in Patients with Diabetes

The medical management of osteoarticular infections in patients with diabetes continues to be a considerable clinical dilemma because of inadequate blood supply and weakened immune systems. The objective of this study is to assess the effectiveness of dissolvable synthetic pure calcium sulfate beads with antibiotics in the treatment of osteoarticular infections in individuals diagnosed with diabetes mellitus. A retrospective analysis was conducted on 27 patients with diabetes (19 with type II diabetes and 8 with type I diabetes) who were diagnosed with osteoarticular infections and received treatment with locally delivered antibiotic-loaded calcium sulfate beads. The patients were monitored for a duration ranging from 6 months to 2 years, during which the clearance of infection, bone remodeling, and rates of recurrence were evaluated. The evaluation also included an assessment of glycemic control and its influence on infection treatment. The findings revealed a notable decrease in the recurrence of infections, as patients who were given combinations of two antibiotics showed better results in comparison to those who were exclusively treated with one antibiotic. A 92% eradication rate was achieved within the trial group, and patients who had dual-antibiotic treatment did not have any return of illness. Postoperative bone remodeling was shown to take place between 8 and 16 weeks, with faster recovery in individuals who maintained ideal glycemic control (HbA1c < 7%). Only one instance of soft tissue necrosis was documented, indicating minimal consequences. The results validate the use of dissolvable synthetic calcium sulfate as a secure and efficient local antibiotic administration method for controlling osteoarticular infections in patients with diabetes, providing improved infection management and facilitating bone regeneration.

Management of chronic septic nonunion of the femur associated with an extended drug resistant nosocomial germ: a case report

Introduction and Importance: Septic nonunion of long bones poses significant treatment challenges, often necessitating extended hospital stays and multiple surgical interventions. This report details a chronic septic nonunion of the femur, complicated by drug-resistant pathogens, managed through an integrated surgical approach. Case Presentation: A 32-year-old male with a history of infected nonunion and multiple failed surgeries presented with a vast bone defect and osteomyelitis. Treatment involved single-session debridement, bone resection, intramedullary fixation, and trifocal segment bone transport using the Limb Reconstruction System (LRS) and Masquelet technique. After eight months, the patient achieved radiologic and clinical bone healing, regained full ambulation, and resumed work without re-infection over an 18-months follow-up. Clinical Discussion: The management of septic nonunion, particularly with drug-resistant infections, requires a multifaceted approach. This case exemplifies the efficacy of combining radical bone resection, targeted debridement, and advanced reconstructive techniques. The use of antibiotic-impregnated cement beads and bone transport procedures played pivotal roles in the successful outcome. While such procedures can be complex and necessitate vigilant monitoring, they are crucial for improving treatment success and functional recovery. Conclusion: Septic nonunion caused by extended drug-resistant germs of the lower extremity long bones can be managed in a single-session bone resection and debridement, local antibiotic administration, and later bone defect reconstruction.

Combining Multiple Spectroscopic Techniques to Reveal the Effects of Staphylococcus aureus Infection on Human Bone Tissues.

Osteomyelitis (OM) and periprosthetic joint infections (PJIs) are major public health concerns in Western countries due to increased life expectancy. Infections usually occur due to bacterial spread through fractures, implants, or blood-borne transmission. The pathogens trigger an inflammatory response that hinders bone tissue regeneration. Treatment requires surgical intervention, which involves the precise removal of infected tissue, wound cleansing, and local and systemic antibiotic administration. Staphylococcus aureus (SA) is one of the most common pathogens causing infection-induced OM and PJIs. It forms antimicrobial-resistant biofilms and is frequently found in healthcare settings. In this proof-of-concept, we present an approach based on multiple spectroscopic techniques aimed at investigating the effects of SA infection on bone tissue, as well as identifying specific markers useful to detect early bacterial colonization on the tissue surface. A cross-section of a human femoral diaphysis, with negative-culture results, was divided into three parts, and the cortical and trabecular regions were separated from each other. Two portions of each bone tissue type were infected with SA for one and seven days, respectively. Multiple techniques were used to investigate the impact of the infection on bone tissue, Brillouin-Raman microspectroscopy and attenuated total reflection Fourier transform infrared spectroscopy were employed to assess and develop a new noninvasive diagnostic method to detect SA by targeting the bone of the host. The results indicate that exposure to SA infection significantly alters the bone structure, especially in the case of the trabecular type, even after just one day. Moreover, Raman spectral markers of the tissue damage were identified, indicating that this technique can detect the effect of the pathogens' presence in bone biopsies and pave the way for potential application during surgery, due to its nondestructive and contactless nature.

A multistage treatment strategy for inflammatory complications following a multisite femur fracture in polytrauma. A case report

Various methods for treating long bone fractures present promising therapeutic possibilities. In the case presented, particular emphasis was placed on the significant effectiveness of local antibiotic administration combined with bone autografts. The complexity of the injury in 23-year-old patient with multifragmentation of the femur, compounded by infection, necessitated a multistage treatment approach.

A Comprehensive Analysis of Liposomal-Based Nanocarriers for Treating Skin and Soft Tissue Infection.

Bacterial skin and soft tissue infections (SSTIs) are widespread microbic invasions of the skin and deeper tissues. Topical drug delivery systems are the most favored administration pathway when treating SSTIs. This is down to their minimal risk of inducing systemic adverse events, reduced development of bacterial resistance, and ease of application. However, they have several drawbacks, including the lack of control over the drug release profile, skin irritations, and the limited permeability of certain compounds through the skin. To address these limitations, several nanocarrier systems were developed, with nanoliposomes standing out as the leading delivery system for the topical management of SSTIs. Despite considerable research into liposomes over the past decade, there remains a gap in detailed knowledge about designing these carriers specifically for SSTIs. Consequently, there is a pressing need for comprehensive research that focuses on the use of nanoliposomes for SSTIs and offers an extensive understanding of both SSTIs and liposomal formulations. This review explores bacterial SSTIs, covering their epidemiology, classification, microbiology, and management. It emphasizes the contribution of liposome-based nanovesicles in enhancing the local administration of antibiotics and natural antibacterial compounds for SSTI management. It also delves into the effects of liposomal formulation changes on the disease therapeutic outcomes. Additionally, it provides a guide for aligning the characteristics of the liposomes with the infection types, depths, properties, and causative agents. This signifies a substantial leap forward in the domains of drug design, development, and delivery.

Smart wireless flexible bandage containing drug loaded polycaprolactone microparticles for real-time monitoring and treatment of chronic wounds.

The quality of life is negatively impacted by chronic wounds for more than 25 million people in the US. They are quite prone to infection, which may lead to the eventual loss of a limb. By exposing the ulcers to treatment agents at the appropriate time, the healing rate is increased. On-demand drug release in a closed-loop system will aid us in reaching our goal. In this study, we have developed a platform capable of real-time diagnosis of bacterial infection by wirelessly reading wound pH, as well as slow and on-demand local administration of antibiotics. The drug carrier microparticles, an electrical patch, a thermoresponsive hydrogel with an integrated microheater, and a flexible pH sensor comprised the closed-loop patch. Here it is reported that slow and smart release of cefazolin can be addressed by incorporation of drug encapsulated hydrophobic microparticles embedded into a thermo-responsive hydrogel. The utilization of a programmable bandage to provide antibiotic medication highlights the need of not only choosing appropriate therapeutic substances but also the controlled release of the medicine and its rate of release within the wound area. The results of our study indicate that the use of cefazolin encapsulated polycaprolactone (PCL) microparticles can effectively regulate the application of antibiotic treatment for chronic skin wounds. The results also showed a substantial gradual release of cefazolin from the thermo-responsive Pnipam hydrogel when the wound dressing was subjected to a temperature of 37°C. We believe that the developed flexible smart bandage can have a significant impact on chronic wound healing.

LOCAL ANTIBACTERIAL TREATMENT IN PATIENTS WITH INFECTED PANCREATIC WALLED-OFF NECROSIS: A SYSTEMATIC REVIEW

Introduction. Systemic antibacterial treatment in patients with infected pancreatic necrosis often fails to resolve the infection due to impaired penetration in necrotic areas. The endoscopic step-up approach based on endoscopic transmural drainage followed, if necessary, by endoscopic necrosectomy has become the standard of care in patients who do not respond to systemic antibiotics. The additional local administration of antibiotics may increase their concentration in necrotic tissue. Aim. To evaluate the efficacy of local infusion of antibacterial agents to the site of infection in addition to systemic treatment after endoscopic drainage to resolve the infection and decrease the need for necrosectomy in patients with walled-off infected pancreatic necrosis. Materials and methods. Major databases were searched for clinical studies assessing the efficacy of local perfusion of antibiotics for the treatment of infected pancreatic necrosis. Results. Four studies were included, two cohort studies and two single-case reports. The majority of patients with infected pancreatic necrosis developed polymicrobial infection. More than one-third of patients additionally had fungal infection. Local irrigation of antibiotics in patients with infected pancreatic necrosis resulted in the eradication of bacteria and fungi, avoiding necrosectomy in almost half of cases. No local or systemic side effects were reported with this strategy. Conclusions. Evidence evaluating the efficacy of local antibiotics for the treatment of infected pancreatic necrosis is scarce. Simultaneous local and systemic administration of antibiotics after endoscopic drainage could reduce the need for necrosectomy. Randomized clinical trials are needed to evaluate the impact of adding local to systemic antibiotics in the prognosis of patients with infected pancreatic necrosis.

Innovative Vancomycin-Loaded Hydrogel-Based Systems - New Opportunities for the Antibiotic Therapy.

Surgical site infections pose a significant challenge for medical services. Systemic antibiotics may be insufficient in preventing bacterial biofilm development. With the local administration of antibiotics, it is easier to minimize possible complications, achieve drugs' higher concentration at the injured site, as well as provide their more sustained release. Therefore, the main objective of the proposed herein studies was the fabrication and characterization of innovative hydrogel-based composites for local vancomycin (VAN) therapy. Presented systems are composed of ionically gelled chitosan particles loaded with vancomycin, embedded into biomimetic collagen/chitosan/hyaluronic acid-based hydrogels crosslinked with genipin and freeze-dried to serve in a flake/disc-like form. VAN-loaded carriers were characterized for their size, stability, and encapsulation efficiency (EE) using dynamic light scattering technique, zeta potential measurements, and UV-Vis spectroscopy, respectively. The synthesized composites were tested in terms of their physicochemical and biological features. Spherical structures with sizes of about 200 nm and encapsulation efficiencies reaching values of approximately 60% were obtained. It was found that the resulting particles exhibit stability over time. The antibacterial activity of the developed materials against Staphylococcus aureus was established. Moreover, in vitro cell culture study revealed that the surfaces of all prepared systems are biocompatible as they supported the proliferation and adhesion of the model MG-63 cells. In addition, we have demonstrated significantly prolonged VAN release while minimizing the initial burst effect for the composites compared to bare nanoparticles and verified their desired physicochemical features during swellability, and degradation experiments. It is expected that the developed herein system will enable direct delivery of the antibiotic at an exposed to infections surgical site, providing drugs sustained release and thus will reduce the risk of systemic toxicity. This strategy would both inhibit biofilm formation and accelerate the healing process.

Advances in Hydrogels for Periodontitis Treatment.

Periodontitis is a common condition characterized by a bacterial infection and the disruption of the body's immune-inflammatory response, which causes damage to the teeth and supporting tissues and eventually results in tooth loss. Current therapy involves the systemic and local administration of antibiotics. However, the existing treatments cannot exert effective, sustained release and maintain an effective therapeutic concentration of the drug at the lesion site. Hydrogels are used to treat periodontitis due to their low cytotoxicity, exceptional water retention capability, and controlled drug release profile. Hydrogels can imitate the extracellular matrix of periodontal cells while offering suitable sites to load antibiotics. This article reviews the utilization of hydrogels for periodontitis therapy based on the pathogenesis and clinical manifestations of the disease. Additionally, the latest therapeutic strategies for smart hydrogels and the main techniques for hydrogel preparation have been discussed. The information will aid in designing and preparing future hydrogels for periodontitis treatment.

Prevention of medication-related osteonecrosis of the jaw after tooth extraction by local administration of antibiotics and atelocollagen sponge: A preliminary study

Background/purposeMedication-related osteonecrosis of the jaw (MRONJ) often develops after extraction of a tooth with a local infection. Therefore, it is necessary to develop extraction methods that can prevent MRONJ. Before examining whether antibiotics and atelocollagen administered in the extraction socket can prevent the development of MRONJ after tooth extraction, this study was conducted to determine the appropriate antibiotics concentration and to conduct a clinical study with a small number of cases as a preliminary study. Materials and methodsFirst, a mixture of minocycline and atelocollagen at different concentrations was implanted into the bone cavity formed in the rabbit head, and the local minocycline concentration was measured after 24 and 48 h. Next, the incidences of MRONJ after tooth extraction in patients receiving high-dose antiresorptive agents were compared between the atelocollagen and atelocollagen/minocycline mixture groups. A group that did not undergo transplantation was also compared as a historical control. ResultsIn animal studies, a mixture of 10 mg/ml minocycline injected into collagen and implanted into the bone cavity showed sufficiently high antimicrobial concentrations, even after 48 h. Post-extraction MRONJ occurred in 3 of the 13 control groups (23.1%), 3 of the 13 atelocollagen groups (23.1%), and 1 of the 13 atelocollagen/minocycline groups (7.7%). ConclusionAtelocollagen functions as a carrier for retaining antibiotics for a certain period. Although this was a study with a limited number of cases, it suggested that the local administration of atelocollagen/minocycline in the extraction socket may reduce the risk of MRONJ following tooth extraction.

Synergistic use of anti-inflammatory ketorolac and gentamicin to target staphylococcal biofilms

BackgroundWhile antibiotics remain our primary tools against microbial infection, increasing antibiotic resistance (inherent and acquired) is a major detriment to their efficacy. A practical approach to maintaining or reversing the efficacy of antibiotics is the use of other commonly used therapeutics, which show synergistic antibacterial action with antibiotics. Here, we investigated the extent of antibacterial synergy between the antibiotic gentamicin and the anti-inflammatory ketorolac regarding the dynamics of biofilm growth, the rate of acquired resistance, and the possible mechanism of synergy.MethodsControl (ATCC 12600, ATCC 35984) and clinical strains (L1101, L1116) of Staphylococcus aureus and Staphylococcus epidermidis with varying antibiotic susceptibility profiles were used in this study to simulate implant-material associated low-risk and high-risk biofilms in vitro. The synergistic action of gentamicin sulfate (GS) and ketorolac tromethamine (KT), against planktonic staphylococcal strains were determined using the fractional inhibitory concentration measurement assay. Nascent (6 h) and established (24 h) biofilms were grown on 316L stainless steel plates and the synergistic biofilm eradication activity was determined and characterized using adherent bacteria count, minimum biofilm eradication concentration (MBEC) measurement for GS, visualization by live/dead imaging, scanning electron microscopy, gene expression of biofilm-associated genes, and bacterial membrane fluidity assessment.ResultsGentamicin-ketorolac (GS-KT) combination demonstrated synergistic antibacterial action against planktonic Staphylococci. Control and clinical strains showed distinct biofilm growth dynamics and an increase in biofilm maturity was shown to confer further resistance to gentamicin for both ‘low-risk’ and ‘high-risk’ biofilms. The addition of ketorolac enhanced the antibiofilm activity of gentamicin against acquired resistance in staphylococcal biofilms. Mechanistic studies revealed that the synergistic action of gentamicin–ketorolac interferes with biofilm morphology and subverts bacterial stress response altering bacterial physiology, membrane dynamics, and biofilm properties.ConclusionThe results of this study have a significant impact on the local administration of antibiotics and other therapeutic agents commonly used in the prevention and treatment of orthopaedic infections. Further, these results warrant the study of synergy for the concurrent or sequential administration of non-antibiotic drugs for antimicrobial effect.

Dental Biopolymer Composites with Antibiotics, Bisphosphonate, and Hydroxyapatite for Possible Use in Bone Tissue Regeneration

The aim of the present study was to formulate new variants of synthetic and animal-source bone materials coated with different biopolymers, containing antibiotics (ampicillin and oxacillin) and alendronate drugs. Validation consists in establishing mixtures that do not present interactions between components. These materials should act as a drug delivery system alongside the bone base. Natural polymers such as chitosan, alginate, and kappa-carrageenan have been shown to be optimal materials for drug delivery due to their intrinsic biocompatibility. Binary, ternary, and quaternary mixtures between components are analyzed by FT-IR spectroscopy, UV-Vis analysis, thermogravimetry (TGA), and scanning electron microscopy (SEM). The analysis led to the validation of materials suitable for the controlled release of active substances, which have the greatest chance of increasing the speed of bone regeneration, as well as helping in the local administration of antibiotics, which currently must be administered in the form of oral formulations or an injection. According to the FTIR, thermogravimetry, UV-Vis, SEM, and cytotoxicity tests performed in this study, it can be said that it is quite easy to obtain materials that can be used in dental practice that facilitate bone reconstruction through local treatment. At the same time, it was found that both active substances can be incorporated into the material together with Alg and Chit, thus limiting the adverse effects and maximizing the local beneficial effects.

Y-Branched Titanium Dioxide Nanotubes as a Potential Antimicrobial Coating for Implants

The early loss of dental implants can be avoided with systemic antibiotics, however there are potentially significant side effects. Consequently, the use of local drug administration techniques is necessary to make dental implant therapy more practical. In this study, Y-branched nanotubes were prepared by non-expensive and simple anodization in two steps. Tests were performed to highlight their potential for local antibiotic administration. Y-branched nanotubes were able to incorporate a dose of Tetracycline and ensure its electrochemical stability. The presence of tetracycline significantly enhanced antibacterial efficacy, resulting in an increase of up to 55% for Escherichia coli and Pseudomonas aeruginosa and 50% for Staphylococcus aureus. The comparable antibacterial effects of the nanostructured surfaces highlight the potential of tetracycline in promoting antimicrobial action. Moreover, the addition of tetracycline does not influence the structural, morphological and stability properties of the nanostructured deposited TiO2 films.

Triple Antibiotic Paste: Boon to Dentistry

Microorganisms must be removed from the root canal (RC) and periapical region for endodontic success. A sterile state cannot be achieved with only endodontic instrumentation. Local administration of antibiotics has been studied in light of the development of non-instrumentation endodontic treatment, tissue healing and lesion sterilization. Triple antibiotic paste (TAP) with metronidazole, ciprofloxacin, and minocycline works well for non-vital young permanent teeth and the RC pathogen. Present review of literature aims to discuss role of TAP in endodontic treatment.

Local Administration of Antibiotics in Orthopedics and Traumatology.

2022 marks the 50th anniversary of the development of the antibiotic loaded PMMA chain. The loading of bone cements with antibiotics was a major advance in the treatment of musculoskeletal infections and is still a proven standard today. The research and use of novel antibiotic carriers continues to be an important part of research in the context of musculoskeletal infections. The article provides an overview of the various local antibiotics available and their specifics. In addition, current adapted treatment concepts are discussed.

Alternative Antimicrobial Irrigation Strategies for the Treatment of Infections in Children: A Review of the Existing Literature.

As a synergistic treatment approach with systemic antimicrobial therapy or a systemic antibiotic-sparing strategy, the local administration of antimicrobial agents has been proposed as an alternative route for complicated infections. With the rationale of concentrating the active principle in the desired target site, avoiding potentially toxic systemic levels and bypassing anatomical and physiological barriers, local irrigation or infusion of antibiotics may effectively shorten the antimicrobial therapy course and reduce both infection-related and systemic therapy-related complications. Although evidence from the adult population supports its use in selected patients with an acceptable safety profile, data specifically focused on the pediatric population are limited. To provide a rapid and easily accessible tool for clinical practice, we synthesized the most relevant evidence on the use of local antimicrobial agents in common severe infections in children: meningitis, mediastinitis, pleural infections, recurrent urinary infections, and peritonitis. A literature search was performed using predefined combined keywords through an electronic research database (PubMed). Described molecules, dosages, routes, treated age groups, and related efficacy have been summarized for prompt application to clinical practice. It should, however, be noted that the evidence for the pediatric population remains limited, and the local administration of several molecules remains off-label. A careful multidisciplinary and patient-tailored evaluation, as well as a rational use of available guidelines, should always be the basis of clinical decision making in settings where local administration of antibiotics may be considered.

Topical Nanotherapeutics for Treating MRSA-Associated Skin and Soft Tissue Infection (SSTIs).

The emergence of methicillin-resistant Staphylococcus aureus (MRSA) imposes a major challenge for the treatment of infectious diseases with existing antibiotics. MRSA associated with superficial skin and soft tissue infections (SSTIs) is one of them, affecting the skin's superficial layers, and it includes impetigo, folliculitis, cellulitis, furuncles, abscesses, surgical site infections, etc. The efficient care of superficial SSTIs caused by MRSA necessitates local administration of antibiotics, because oral antibiotics does not produce the required concentration at the local site. The topical administration of nanocarriers has been emerging in the area of drug delivery due to its advantages over conventional topical formulation. It enhances the solubility and permeation of the antibiotics into deeper layer of the skin. Apart from this, antibiotic resistance is something that needs to be combated on multiple fronts, and antibiotics encapsulated in nanocarriers help to do so by increasing the therapeutic efficacy in a number of different ways. The current review provides an overview of the resistance mechanism in S. aureus as well as various nanocarriers reported for the effective management of MRSA-associated superficial SSTIs.

Mesenchymal stromal cells modulate infection and inflammation in the uterus and mammary gland

The use of mesenchymal stromal cells (MSCs) is emerging as an efficacious and safe treatment for many infectious and non-infectious inflammatory diseases in human and veterinary medicine. Such use could be done to treat mastitis and metritis, which are the most common disease conditions affecting dairy cows leading to considerable economic losses and reduced animal welfare. Currently, both disease conditions are commonly treated using local and systemic administration of antibiotics. However, this strategy has many disadvantages including low cure rates and the public health hazards. Looking for alternative approaches, we investigated the properties of MSCs using in-vitro mammary and endometrial cell systems and in-vivo mastitis and metritis murine model systems. In-vitro, co-culture of mammary and uterus epithelial cells constructed with NF-kB reporter system, the master regulator of inflammation, demonstrated their anti-inflammatory effects in response to.LPS. In vivo, we challenge animals with field strains of mammary and utero pathogenic Escherichia coli and evaluated the effects of local and systemic application of MSC in the animal models. Disease outcome was evaluated using histological analysis, bacterial counts and gene expression of inflammatory markers. We show that MSC treatment reduced bacterial load in metritis and significantly modulated the inflammatory response of the uterus and mammary gland to bacterial infection. Most notably are the immune modulatory effects of remotely engrafted intravenous MSCs, which open new avenues to the development of MSC-based cell-free therapies.

The efficacy of implant surface decontamination using chemicals during surgical treatment of peri-implantitis: A systematic review and meta-analysis.

To answer the following PICOS question: "In adult patients with peri-implantitis, what is the efficacy of surgical therapy with chemical surface decontamination of implant surfaces in comparison with surgical therapy alone or surgery with placebo decontamination, on probing pocket depth (PD) reduction and bleeding on probing (BoP)/suppuration on probing (SoP), in randomized controlled clinical trials (RCTs) and non-RCTs with at least 6months of follow-up?" Six databases were searched from their inception up to 20 May 2022. Data on clinical outcome variables were pooled and analysed using mean differences (MDs), risk ratios (RRs), or risk differences (RDs) as appropriate, 95% confidence intervals (CIs), and prediction intervals (PIs) in the case of significant heterogeneity. Primary outcomes were determined as changes in PD and BoP/SoP. Secondary outcomes were radiographic marginal bone loss (MBL), implant loss, and disease resolution. PROSPERO registration number: CRD42022325603. Six RCTs-two with moderate, three with high, and one with low risk of bias (RoB)-were included. These studies test the adjunctive effect of photodynamic therapy (PDT), chlorhexidine (CHX), and administration of local antibiotics (LAbs) during surgery on the clinical outcome. In a single 12-month study, the adjunctive use of local antibiotics showed a clinically relevant reduction of PD [MD=1.44; 95%CI (0.40 to -2.48)] and MBL [MD=1.21; 95%CI (0.44-1.98); one trial, 32 participants]. PDT showed a small but significant reduction in BoP [MD=7.41%; 95%CI (0.81-14.00); p= 0.028; two trials; 42 participants]. Treatment with CHX resulted in no significant changes in PD, BoP, or MBL compared to placebo (saline solution). None of the interventions affected disease resolution and implant loss. Certainty of the evidence was very low for all outcome measures assessed. Within the limitations of this systematic review and the meta-analysis, adjunctive use of chemicals such as PDT, CHX, and LAbs for surface decontamination during surgery of peri-implantitis cannot be recommended as superior to standard debridement procedures (mechanical debridement with or without saline).

Local administration of vancomycin powder in orthopaedic fracture surgery: current practice and trends.

Surgical site infections in orthopaedic trauma are a significant problem with meaningful patient and health care system-level consequences. Direct application of antibiotics to the surgical field has many potential benefits in reducing surgical site infections. However, to date, the data regarding the local administration of antibiotics have been mixed. This study reports on the variability of prophylactic vancomycin powder use in orthopaedic trauma cases across 28 centers. Intrawound topical antibiotic powder use was prospectively collected within three multicenter fracture fixation trials. Fracture location, Gustilo classification, recruiting center, and surgeon information were collected. Differences in practice patterns across recruiting center and injury characteristics were tested using chi-square statistic and logistic regression. Additional stratified analyses by recruiting center and individual surgeon were performed. A total of 4941 fractures were treated, and vancomycin powder was used in 1547 patients (31%) overall. Local administration of vancomycin powder was more frequent in open fractures 38.8% (738/1901) compared with closed fractures 26.6% (809/3040) (P < 0.001). However, the severity of the open fracture type did not affect the rate at which vancomycin powder was used (P = 0.11). Vancomycin powder use varied substantially across the clinical sites (P < 0.001). At the surgeon level, 75.0% used vancomycin powder in less than one-quarter of their cases. Prophylactic intrawound vancomycin powder remains controversial with varied support throughout the literature. This study demonstrates wide variability in its use across institutions, fracture types, and surgeons. This study highlights the opportunity for increased practice standardization for infection prophylaxis interventions. Prognostic-III.