Vancomycin Powder Research Articles

Topical Application of Vancomycin Powder to Prevent Infections after Massive Bone Resection and the implantation of Megaprostheses in Orthopaedic Oncology Surgery.

Periprosthetic joint infection (PJI) represents a serious burden in orthopaedic oncology. Through the years, several local expedients have been proposed to minimise the risk of periprosthetic infection. In this study, we report our outcomes using topical vancomycin powder (VP) with the aim to prevent PJIs. Fifty oncological cases treated with massive bone resection and the implant of a megaprosthesis were included in our study. Among them, 22 [(GGroup A) received one gram of vancomycin powder on the surface of the implant and another gram on the surface of the muscular fascia]. The remaining 28 did not receive such a treatment (Group B). The rest of surgical procedures and the follow-up were the same for the two groups. Patients underwent periodical outpatient visits, radiographs and blood exams' evaluations. Diagnosis of PJIs and adverse reactions to topical vancomycin were recorded. None of the cases treated with topical vancomycin developed infections, whereas 6 of the 28 cases (21.4%) who did not receive the powder suffered from PJIs. These outcomes suggest that cases treated with VP had a significantly lower risk of post-operative PJI (p=0.028). None of our cases developed acute kidney failures or any other complication directly or indirectly attributable to the local administration of VP. The topical use of vancomycin powder on megaprosthetic surfaces and the overlying fascias, alongside with a correct endovenous antibiotic prophylaxis, can represent a promising approach in order to minimise the risk of periprosthetic infections in orthopaedic oncology surgery.

A Sodium Oxychlorosene-Based Infection Prevention Protocol Safely Decreases Postoperative Wound Infections in Adult Spinal Deformity Surgery.

This study sought to determine the efficacy of a complex multi-institutional sodium oxychlorosene-based infection protocol for decreasing the rate of surgical site infection after instrumented spinal surgery for adult spinal deformity (ASD). Infection prevention protocols have not been previously studied in ASD patients. A retrospective analysis was performed of patients who underwent posterior instrumented spinal fusion of the thoracic or lumbar spine for deformity correction between January 1, 2011, and May 31, 2019. The efficacy of a multi-modal infection prevention protocol was examined. The infection prevention bundle consisted of methicillin-resistant Staphylococcus aureus testing, chlorhexidine gluconate bathing preoperatively, sodium oxychlorosene rinse, vancomycin powder placement, and surgical drain placement at the time of surgery. About 254 patients fit the inclusion criteria. Among these patients, nine (3.5%) experienced post-surgical deep-wound infection. Demographics and surgical characteristics amongst infected and non-infected cohorts were similar, although diabetes trended towards being more prevalent in patients who developed a postoperative wound infection (p=0.07). Among 222 patients (87.4%) who achieved a minimum of two years of follow-ups, 184 patients (82.9%) experienced successful fusion, comparing favorably with pseudarthrosis rates in the ASD literature. Rates of pseudarthrosis and proximal junction kyphosis were similar amongst infected and non-infected patients. An intraoperative comprehensive sodium oxychlorosene-based infection prevention protocol helped to provide a low rateof infection after major deformity correction without negatively impacting other postoperative procedure-related metrics.

Effect of Different Local Antibiotic Regimens on Prevention of Postoperative Infection in Clean Surgical Wounds: A Systematic Review and Network Meta-analysis.

To compare the efficacy of several local antibiotic regimens in preventing surgical site infection (SSI) in clean surgical wounds. The authors searched CNKI (China National Knowledge Infrastructure), the VIP (VIP information resource integration service platform), Wanfang Data knowledge service platform (WANFANG), SinoMed, Cochrane Library, EMBASE, and PubMed. A total of 20 randomized controlled trials published between January 1, 2000 and April 1, 2021 were included in this meta-analysis. Authors extracted the name of the first author, publication date, country, type of surgery, follow-up time, mean age of participants, sample size of each group, interventions, outcome indicators, and study type from each article. The overall effectiveness of eight local managements in reducing the incidence of the SSI effect were compared through the SUCRA (surface under the cumulative ranking curve) probabilities. The results of a network meta-analysis demonstrated that gentamicin ointment (odds ratio [OR], 0.16; 95% CI, 0.04-0.60), mupirocin ointment (OR, 0.44; 95% CI, 0.21-0.94), and gentamicin soaking of the graft (OR, 0.63; 95% CI, 0.44-0.91) significantly reduced the incidence of SSI compared with control. Further, vancomycin soaking of the graft (86.7%) ranked first, followed by gentamicin ointment (81.1%), gentamicin irrigation (79.9%), mupirocin ointment (56.8%), triple antibiotic ointment (47.8%), gentamicin soaking of the graft (42.3%), and vancomycin powder (22.1%); ampicillin powder (17.8%) was the least effective drug. The findings indicate that local antibiotics combined with conventional antibiotics in the wound before wound closure are effective in reducing the incidence of SSI in clean surgical wounds. Vancomycin inoculation of the graft exhibited the best effect.

Prophylactic use of vancomycin powder on postoperative infection after total joint arthroplasty

ObjectiveBy reviewing the literature analyzing vancomycin powder for preventive surgery, the effect of this method on reducing the infection rate after TJA was systematically evaluated to provide a basis for future clinical work.MethodsUsing PubMed, Medline, Elsevier, and CNKI, with the following mesh words: “vancomycin”, “local / intraoperative / topical / intrawound”, “TJA”, “TKA”, “THA”, “total joint arthroplasty”, “total knee arthroplasty”, “total hip arthroplasty”, “infection”, and “SSI”, to search for case-control research papers on the impact of prophylactic application of vancomycin powder on the incidence of postoperative infection, we compared the overall infection rate in the literature by using RevMan 5.3 meta-analysis software and analyzed the impact of vancomycin on the infection rate of different parts and types of TJA according to different subgroups.ResultsA total of 22 qualified studies were selected; twenty-five studies compared the effect of prophylactic use of vancomycin powder on infection rates after TJA. There were 23,363 cases in total, including 9545 cases in the vancomycin group and 13,818 cases in the control group. The results of the meta-analysis showed that the possibility of postoperative infection after prophylactic use of vancomycin powder was significantly lower than that without vancomycin risk ratio: 0.38 [0.23,0.59], P < 0.01). However, a meta-analysis of randomized controlled trials (RCTs) showed no significant effect of vancomycin on postoperative infection (P = 0.52).ConclusionBased on the retrospective studies, local prophylactic use of vancomycin powder in TJA can significantly reduce the incidence of postoperative infection. High-quality RCTs should be carried out to further evaluate these results.

Management of Traumatic Bone Defects in Tibial Plateau Fractures with Antibiotic-Impregnated Biodegradable Calcium Sulfate Beads: A Prospective Clinical Trial

Objectives: The purpose of this study was to assess adverse events and resorption of antibiotic-impregnated calcium sulfate beads used as a nonstructural void filler in tibia plateau fractures. This device may be more adaptable to a specific bacterium than vancomycin powder as it allows the mixtures of specific bactericidal antibiotics to treat bacterium with specific sensitivities. Design: A multicenter, non-randomized, uncontrolled prospective cohort study. Setting: Five level 1 trauma centers. Participants: Thirty adults with an acute closed tibia plateau fracture, OTA 41B and 41C fractures, requiring operative fixation. Intervention: After fracture fixation, the subchondral bone void was filled with the study device. Main Outcome Measures: Local wound reaction to the device was assessed and resorption of the calcium sulfate was measured on serial x-rays. Follow-up assessments occurred at six weeks, three months, six months and one year, with a CT scan performed at six months to determine resorption of the device. Results: Thirteen male and 17 female participants were recruited with a mean age of 53.3 ± 12.8 years. The median age was 55 years with a range of 29 to 78 years of age. Two participants reported serous drainage: one resolved without treatment, the other was diagnosed as a deep infection and required plate removal and oral antibiotics. There were no local or systemic allergic reactions. Resorption of the material averaged 70% by three months, 87% at six months, and 100% at one year. Conclusions: This device performed as anticipated and completely resorbed without any unexpected adverse events. It allowed for personalizing antibiotic choice with better reported elutional characteristics than vancomycin powder over two weeks and six weeks. Surgical site drainage was low, and 97% union rate was achieved. This is a safe surgical augment for local release of a chosen antibiotic into a contained subchondral defect in a periarticular fracture.

Impact of Vancomycin Powder and Aerobic Exercise on the Clinical Symptoms and Health-Related Quality of Life after Total Hip Arthroplasty

Impact of Vancomycin Powder and Aerobic Exercise on the Clinical Symptoms and Health-Related Quality of Life after Total Hip Arthroplasty

The VANCO Trial Findings Are Generalizable to a North American Trauma Registry

OBJECTIVES: To estimate the generalizability of treatment effects observed in the VANCO trial to a broader population of patients with tibial plateau or pilon fractures. METHODS: Design and Setting: Clinical trial data from 36 United States trauma centers and Trauma Quality Programs registry data from more than 875 Level I–III trauma centers in the United States and Canada. Patient Selection Criteria: Patients enrolled in the VANCO trial treated with intrawound vancomycin powder from January 2015 to June 2017 and 31,924 VANCO-eligible TQP patients admitted in 2019 with tibial plateau and pilon fractures. Outcome Measure and Comparisons: Deep surgical site infection and gram-positive deep surgical site infection estimated in the TQP sample weighed by the inverse probability of trial participation. RESULTS: The 980 patients in the VANCO trial were highly representative of 31,924 TQP VANCO-eligible patients (Tipton generalizability index 0.96). It was estimated that intrawound vancomycin powder reduced the odds of deep surgical infection by odds ratio (OR) = 0.46 (95% confidence interval [CI] 0.25–0.86) and gram-positive deep surgical infection by OR = 0.39 (95% CI, 0.18–0.84) within the TQP sample of VANCO-eligible patients. For reference, the trial average treatment effects for deep surgical infection and gram-positive deep surgical infection were OR = 0.60 (95% CI, 0.37–0.98) and OR = 0.44 (95% CI, 0.23–0.80), respectively. CONCLUSIONS: This generalizability analysis found that the inferences of the VANCO trial generalize and might even underestimate the effects of intrawound vancomycin powder when observed in a wider population of patients with tibial plateau and pilon fractures. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Topical Vancomycin as a Tool for the Prevention of Surgical Site Infections in Cranial Neurosurgery: A Retrospective Cohort Study

BACKGROUND AND OBJECTIVES: Surgical site infections (SSI) in neurosurgery result in prolonged hospitalizations, readmissions, poor outcomes, and even death. Prevention of SSI remains paramount to mitigate the risk of this complication. In this study, we aimed to evaluate the effect of topical use of vancomycin powder during surgical closure in cranial surgery for the reduction of SSI. METHODS: This is a retrospective cohort study of cranial neurosurgical patients from 2016 to 2022 in Fundación Santa Fe de Bogotá. Baseline clinical and surgical characteristics were collected, as well as vancomycin powder use. The primary outcome of interest was SSI within 90 days after surgery. A P value of .05 was considered significant. RESULTS: We found a total of 1395 patients, of which 1108 met the selection criteria. Surgical site infection was seen in 32 patients (2.9%). Topical use of vancomycin powder during surgical closure was associated with a lower frequency of SSI in cranial surgery n = 10 (2.3%) relative to those who did not use vancomycin n = 22 (3.3%), and it was found to be a protective factor in the multinomial regression, with a statistically significant result (relative risk = 0.397, P = .034). CONCLUSION: The evidence supporting the use of vancomycin powder during surgical closure is currently weak, as the association did not reach statistical significance in the primary analysis. However, a P value of less than 0.05 was obtained in the multivariate analysis. To further assess the efficacy of this intervention, additional randomized prospective studies are needed.

Scalp Incisions With Stairstep Pericranial Edges to Minimize Sequalae from Poor Wound Healing in Supratentorial Brain Tumor Surgery: A Technical Note With Early Results

BACKGROUND AND OBJECTIVES: Wound healing problems are especially prevalent in craniotomies for intra-axial brain tumors as patients often require radiation, chemotherapy, and chronic steroids. Although newer techniques such as minimally invasive approaches and routine vancomycin powder use have helped overall complication rates, poor skin healing remains a frustratingly persistent cause of morbidity. Therefore, here we describe the novel technique of elevating and closing a stairstep pericranial edge offset from the skin incision to protect hardware and support wound healing, and we report early outcomes using this technique. METHODS: Ninety-one consecutive patients underwent supratentorial, intra-axial brain tumor surgery with a single surgeon at a single institution using this technique. Patient demographics, pathology, adjuvant interventions, and other independent risk factors were analyzed. RESULTS: No wound-related complications requiring readmission, intravenous antibiotics, or reoperation were encountered at a median 3-month follow-up. There were also no surgical site infections, dehiscences, or cerebrospinal fluid leaks. Fifty-one patients (57.3%) had postoperative radiotherapy, 85 patients (93.4%) had perioperative steroids, and 56 patients (61.5%) had postoperative chemotherapy. Six patients (6.5%) were placed on a short course of oral antibiotics perioperatively due to concerns with initial scalp healing (ie, excessive scabbing at follow-up), none of whom progressed to infection or required further intervention. These are the cases where this technique is felt to have been most helpful by potentially preventing worse sequelae. One patient developed a shunt infection during this interval that required removal unrelated to the craniotomy site. CONCLUSION: Here we outline in detail the principles, design, and execution of incisions and closures with stairstep pericranial edges in supratentorial brain surgery. This technique was designed in consultation with plastic surgeons to provide an intact, vascularized layer of pericranium beneath the healing skin and over the bone graft/hardware to optimize wound healing conditions and prevent morbid sequelae in inevitable cases of poor initial healing. Early results are promising.

Effects of Placing Anterior Cruciate Ligament Grafts in Vancomycin Powder Reduces Infection Rate

Effects of Placing Anterior Cruciate Ligament Grafts in Vancomycin Powder Reduces Infection Rate

Does topical vancomycin prevent fracture-related infections in closed fractures undergoing open reduction and internal fixation? A randomised controlled trial

PurposeThe role of topical vancomycin in fracture-related infection (FRI) is debatable. Very few studies have reported their efficacy in open and high-risk extremity fractures. This study aimed to assess topical vancomycin's role in reducing FRI in closed fractures undergoing open surgical intervention with an implant. MethodsThis prospective randomized cohort study was carried out between February 2021 to January 2022. Patients with isolated closed fractures, who were planned for open reduction and internal fixation within 2 weeks from the time of injury were included for this study. The data collected included age, gender, socioeconomic status, mechanism of injury, diagnosis, Tscherne classification, and time interval to take up for surgery. Patients were randomized into the intervention and control groups using the block randomization technique. The control group received only systemic antibiotic prophylaxis, whereas the intervention group received topical application of vancomycin powder in the surgical wound alongside systemic antibiotic prophylaxis. The primary outcome measure was the incidence of FRI among these individuals. Clinical and radiological findings and culture reports (in cases with infection) were recorded during the post-operative period and at 6 weeks of follow-up. All relevant statistical calculations were done using STATA statistical/data analysis-parallel edition version 16.0 (StataCorp LLC). The quantitative variables like age and duration of the surgery were assessed for normalcy by Shapiro-Wilk W test. An independent samples t-test with equal variances was applied to the age data. Fisher's exact test was used for the analysis of the primary outcome measure (presence of FRI following surgery), and “Risk of FRI” and “Risk difference” between the 2 groups was calculated. The strength of the association between qualitative variables was assessed using the Fisher's exact and Chi-square tests, respectively. ResultsThere were 88 patients included in this study. No statistical significance was found about FRI between both groups (p = 0.494). At 6 weeks following surgery, no incidence of infection was observed in the intervention group. Two infections (4.5%) were found in the control group, with positive cultures reported in one of them but none in the treatment group. Radiologically, 15.9% of patients in the control group showed lysis around the implant compared to 2.3% in the intervention group. Impaired fracture healing was observed in 22.7% of patients in the intervention group compared to 15.9% in the control group. ConclusionApplying topical vancomycin in closed fractures undergoing open reduction and internal fixation does not significantly reduce the incidence of FRI until the end of 6 weeks following surgery.

Prophylactic Intrawound Antibiotics Significantly Reduce the Risk of Deep Infections in Fracture Fixation: Subgroup Metanalyses of the Type of Fracture, Antibiotics, and Organism.

To analyze the efficacy of subgroups of various intrawound local antibiotics in reducing the rate of fracture-related infections (FRI). and study selection: PubMed, MEDLINE via Ovid, Web of Science, Cochrane database, and Science Direct were searched for articles in English on July 5, 2022 and December 15, 2022. All clinical studies comparing the incidence of FRI between administration of prophylactic systemic and topical antibiotics in fracture repair were analyzed. Cochrane collaboration's assessment tool and the methodological bias and the methodological index for nonrandomized studies were used to detect bias and evaluate the quality of included studies, respectively. Data synthesis: RevMan 5.3 software. (Nordic Cochrane Centre, Denmark) was used to conduct the meta-analyses and generate forest plots. From 1990 to 2021, 13 Studies included 5,309 patients. Non-stratified meta-analysis showed that intrawound administration of antibiotics significantly decreased the overall incidence of infection in both open and closed fractures, regardless of the severity of open fracture and antibiotics class [OR= 0.58, P= 0.007)] [OR= 0.33, P<0.00001)], respectively. The stratified analysis revealed that prophylactic intrawound antibiotics significantly lowered infection rate in open fracture patients with Gustilo-Anderson Type I (OR=0.13, p=0.004), Type II (OR=0.29, p=0.0002), Type III (OR=0.21, p<0.00001), when either Tobramycin PMMA beads (OR=0.29, p<0.00001), or vancomycin powder (OR=0.51, p=0.03) was applied. This study demonstrates prophylactic administration of intrawound antibiotics significantly decreases the overall incidence of infection in all subgroups of surgically fixated fractures but does not affect. Level II. See Instructions for Authors for a complete description of levels of evidence.

Postoperative infection problems in DBS applications

Deep brain stimulation (DBS) is a significant neuromodulation method for treating neurological and psychiatric disorders. Despite its efficacy, complications, particularly infections, are a concern. This article reviews the prevalence, risk factors, pathogens, infection locations, timing, surgical approaches, prevention strategies, and treatment methods associated with infections following DBS procedures. DBS surgeries have gained popularity due to their adjustability, but infections pose challenges. Surgical site infections (SSIs) are common (0% to 24% cases) and extensively studied regarding patient groups, locations, timing, and pathogens. Expanding patient groups, including conditions like Tourette syndrome and epilepsy, have varying infection risks. Infections occur at burr-hole, extension, and implantable pulse generator (IPG) sites. Staphylococcus aureus is a primary pathogen, yet bacterial DNA on IPGs and colonization complicate understanding. Surgical approaches, staged or non-staged, show comparable infection rates. The influence of repetitive pulse generator replacements on infection rates is debated. Lead externalization, topical vancomycin powder, and other factors impact infection risk. Treating DBS-related infections often requires hardware extraction and antibiotic treatment. Innovations like ethylene oxide sterilization and hydrogen peroxide show potential. Algorithms suggest partial explantation for localized infections. Cost analyses favor starting with antibiotics. Infections persist despite progress; understanding risks, pathogens, and strategies is vital for optimal outcomes in DBS.

Intraarticular vancomycin decreased the risk of acute postoperative periprosthetic joint infection without increasing complication in primary total joint arthroplasty—a prospective study

ObjectivesTo investigate the preventive effect of intraarticularly administered vancomycin on acute postoperative periprosthetic joint infection (PJI) in total joint arthroplasty (TJA). MethodsConsecutive patients who underwent unilateral primary TJA were prospectively enrolled. The patients were divided into vancomycin group and control group according to whether 1 g of vancomycin powder suspended in 30 ml normal saline was intraarticularly administered after arthrotomy closure. Acute postoperative PJI and aseptic wound complication were evaluated within 3 months postoperatively. Vancomycin-associated toxicity including acute renal failure, ototoxicity and anaphylaxis was also evaluated. ResultsIn terms of demographic parameters and comorbidities, no significant difference was found between the two groups. Intra-articular vancomycin significantly lowered the risk of acute postoperative PJI after primary TJA (P = 0.015) and primary total knee arthroplasty (P = 0.031). However, for patients who underwent total hip arthroplasty, the PJI rate was comparable between the two groups. Overall, the risk of aseptic wound complication between the two groups was also similar. Vancomycin-associated acute renal injury, ototoxicity, or anaphylaxis was not observed. ConclusionsIntra-articular injection of 1 g of vancomycin suspension after arthrotomy closure during TJA lowered the risk of acute postoperative PJI without increasing the risk of aseptic wound complication and vancomycin-associated systemic toxicity.

The stability of Staphylococcal bacteriophage in presence of local vancomycin concentrations used in clinical practice.

To evaluate the stability of a clinically used Staphylococcal bacteriophage with doses of vancomycin that are encountered with local administration of vancomycin for musculoskeletal infections. A Staphylococcal bacteriophage was evaluated for stability in different pH ranges. Then that same bacteriophage was evaluated for stability with different concentrations of vancomycin and with vancomycin biodegradable antibiotic beads. The bacteriophage had stability within a pH range of 4-10. There was a statistically significant (P < 0.05) decrease in the amount of bacteriophage over 24h for vancomycin concentrations of 10mg/mL and 100mg/mL compared to lower vancomycin concentrations (1mg/mL, 0.1mg/mL and normal saline). However, no statistically significant decrease in the amount of bacteriophage was seen with biodegradable vancomycin beads over 24h. These findings have important clinical ramifications in that they show local administration of bacteriophages with concomitant local vancomycin powder therapy should be avoided. Moreover, these findings should spearhead further research into bacteriophage stability in in vivo environments.

Perioperative Means to Prevent Surgical Site Infections following Elective Craniotomies: A Single-Center Experience.

Background Postoperative surgical site infections are a recognized complication following craniotomies with an associated increase in morbidity and mortality. Several studies have attempted to identify bundles of care to reduce the incidence of infections. Our study aims to clarify which perioperative measures play a role in reducing surgical infection rates further. Methods This study is a retrospective audit of all elective craniotomies in years 2018 to 2019. The primary endpoint was the surgical site infection rate at 30 days and 4 months after the procedure. Univariate analysis was used to identify factors predictive of postoperative infection. Results 344 patients were included in this study. Postoperative infections were observed in 5.2% of our cohort. No postoperative infections occurred within 4 months in patients receiving perioperative hair wash and intrawound vancomycin powder. In univariate analysis, craniotomy size (Fisher's exact test, p = 0.05), lack of perioperative hair wash, and vancomycin powder use (Fisher's exact test, p = 0.01) were predictive of postoperative infection. No complications relative to the use of intrawound vancomycin were observed. Conclusion Our study demonstrates that simple measures such as perioperative hair wash combined with intrawound vancomycin powder in addition to standard practice can help reducing infection rates with negligible risks and acceptable costs. Our results should be validated further in future prospective studies.

Surgical site infection prophylaxis with intra-wound vancomycin powder for uninstrumented spine surgeries: a meta-analysis.

It is unclear if intra-wound vancomycin powder significantly reduces the infection rate for uninstrumented spine surgery. The purpose of this study is to compare the rate of surgical site infection (SSI) in uninstrumented spine surgery that used vancomycin powder against controls. A search was performed on PUBMED/MEDLINE, Cochrane Database and Embase on 14 October 2022. Search keywords were "vancomycin, spine surgery, uninstrumented and spinal surgery." Instrumented cases were excluded. Type of surgery, type of treatment and incidence of infection among experimental or control were recorded. 288 articles were obtained from a literature search. 16 studies met inclusion criteria. 6/16 studies that reported on the infection rate using vancomycin were obtained. There were 1376 control cases with 20 cases of post-operative infection (1.45% overall). There were 795 cases that received prophylactic intra-wound vancomycin powder with 10 cases of infection reported (1.26%). There was no significant difference in infections between cases that received vancomycin compared to control. On subgroup analysis, studies that had a high rate of infection (Strom and Cannon) had a significant difference on the rate of infection with the use of vancomycin compared to control. The current study was unable to conclude that vancomycin decreased the rate of surgical site infections. Vancomycin use may be useful in populations that have a high rate of infection. Limitations in this study include the small number of studies that report on the use of vancomycin on uninstrumented spine surgery.

Use of topical vancomycin powder in total joint arthroplasty: Why the current literature is inconsistent?

Periprosthetic joint infection (PJI) is a rare but terrible complication in hip and knee arthroplasty, and the use of topical vancomycin powder (VP) has been investigated as a tool to potentially reduce its incidence. However, there remains no consensus on its efficacy. Therefore, the aim of this review is to provide an overview on the application of topical vancomycin in orthopaedic surgery focusing on the recent evidence and results in total joint arthroplasty. Several systematic reviews and meta-analyses on topical VP in hip and knee arthroplasty have been recently published reporting sometimes conflicting results. Apart from all being limited by the quality of the included studies (mostly level III and IV), confounding variables are often included potentially leading to biased conclusions. If taken into consideration the exclusive use of VP in isolation, the available data, although very limited, suggest that it does not reduce the infection rate in routine primary hip and knee arthroplasty. Therefore, we still cannot advise for a routinary application. A properly powered randomized-controlled trial would be necessary to clarify the role of VP in hip and knee arthroplasty. Based on the analysis of the current evidence, the use of topical VP appears to be safe when used locally in terms of systemic adverse reactions, hence, if proven to be effective, it could bring great benefits due to its low cost and accessibility.

Effectiveness of antibiotic-loaded bone cement in total joint arthroplasty at a tertiary medical center: A retrospective cohort study

BackgroundData regarding the effectiveness of antibiotic-loaded bone cement (ALBC) in preventing prosthetic joint infections (PJI) after total joint arthroplasty (TJA) is inconsistent. The objective of this study was to evaluate if the routine use of ALBC influenced the risk of revision surgery due to PJI. MethodsThis is a retrospective cohort study performed between January 2018 and September 2020. Adult patients aged ≥ 18 years who underwent TJA (knee or hip) and received either ALBC or plain cement (PC) were included. The outcome of this study was the rate of revision due to PJI. Multivariate analysis using logistic regression was used to identify factors that may be associated with increased risk of PJI, using STATA 15.1 (StataCorp LP, College Station, Texas, USA). ResultsA total of 844 patients were screened and 319 patients were included. There were 247 patients in ALBC group and 72 patients in the PC group. Only vancomycin powder was used in all ALBC cases, with a 2 g dose in 50% of the cases (dose ranged between 1 g and 8 g). The status of the prosthetic joint was assessed and recorded up to 2 years of the TJA. Overall, the difference in the rates of PJI between the two groups after primary arthroplasty was not statistically significant (5.6% vs 1.4%; p = 0.173; OR, 4.2; 95% CI, 0.5–33). ConclusionALBC was not associated with a reduction in PJI rates after primary TJA. More research is needed to further evaluate the effectiveness of ALBC in preventing PJI.

Vancomycin powder embedded in collagen sponge decreases the rate of prosthetic shoulder infection.

Shoulder arthroplasty is a successful procedure to treat degenerative and traumatic diseases of the glenohumeral joint. Periprosthetic infection represents an infrequent but dreaded complication (2%-4%). Application of intrawound vancomycin powder seems to reduce periprosthetic infections, but limited information is available on its efficiency in shoulder arthroplasty. The purpose of this study was to evaluate if the vancomycin powder embedded in a collagen sponge could decrease the rate of prosthetic shoulder infection. A retrospective analysis of 827 patients undergoing total shoulder arthroplasty was performed. The study involved a control group of 405 patients and a group of 422 with the intraoperative insertion of intrawound vancomycin powder. Incidence of periprosthetic infection was evaluated comparing the 2 groups at a minimum follow-up of 12 months. Patient demographics, comorbidities, and perioperative information were compared between the 2 groups. No infection was observed in the group treated with intrawound vancomycin, and 13 cases of infection were observed in the control group (3.2%) (P value <.001) without subacromial vancomycin application. No wound complications requiring revision were observed as a result of intrawound vancomycin application. Intrawound vancomycin powder significantly reduces the rate of periprosthetic shoulder infections without any increase in local and systemic aseptic complications at a minimum follow-up of 12 months. Our results support the use of intrawound local vancomycin for prophylaxis of shoulder periprosthetic infections.