TY - JOUR
T1 - Distribution of Bacterial Species and Resistance Patterns in Surgical Site Infection after Prior Administration of Vancomycin and Tobramycin Intrawound Powdered Antibiotic Prophylaxis
AU - Peterson, Danielle F.
AU - McKibben, Natasha S.
AU - Lawson, Michelle M.
AU - Taylor, Linh N.
AU - Yang, Qian
AU - Working, Selene
AU - Friess, Darin M.
AU - Working, Zachary M.
N1 - Publisher Copyright:
© 2023 Lippincott Williams and Wilkins. All rights reserved.
PY - 2023/8/1
Y1 - 2023/8/1
N2 - Objective:Evaluate the species distribution and resistance patterns of bacterial pathogens causing surgical site infection (SSI) after operative fracture repair, with and without the use of intrawound powdered antibiotic (IPA) prophylaxis during the index surgery.Design:Retrospective cohort study.Setting:Academic, level 1 trauma center, 2018-2020.Patients/Participants:Fifty-nine deep SSIs were identified in a sample of 734 patients with 846 fractures (IPA [n = 320], control [n = 526]; open [n = 157], closed fractures [n = 689]) who underwent orthopaedic fracture care. Among SSIs, 28 (48%) patients received IPA prophylaxis and 25 (42%) of the fractures were open.Intervention:Intrawound powdered vancomycin and tobramycinMain Outcome Measurements:Distribution of bacterial species and resistance patterns causing deep surgical site infections requiring operative debridement.Results:Zero patients developed infections caused by resistant strains of streptococci, enterococci, gram-negative enterics, Pseudomonas, or Cutibacterium species. The only resistant strains isolated were methicillin resistance (19%) and oxacillin-resistant coagulase-negative staphylococci (16%). There was no associated statistical difference in the proportion of bacterial species isolated, their resistance profiles, or rate of polymicrobial infections between the IPA and control group. Most (93%) cases using IPAs included vancomycin and tobramycin powders. There were 59 SSIs; 28 (9%) in the IPA cohort and 31 (6%) in the control cohort (P = 0.13).Conclusion:The use of local antibiotic prophylaxis resulted in no measurable increase in the proportion of infections caused by resistant bacterial pathogens after operative treatment of fractures. However, the small sample size and limited time frame of these preliminary data require continued investigation into their role as an adjunct to SSI prophylaxis.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
AB - Objective:Evaluate the species distribution and resistance patterns of bacterial pathogens causing surgical site infection (SSI) after operative fracture repair, with and without the use of intrawound powdered antibiotic (IPA) prophylaxis during the index surgery.Design:Retrospective cohort study.Setting:Academic, level 1 trauma center, 2018-2020.Patients/Participants:Fifty-nine deep SSIs were identified in a sample of 734 patients with 846 fractures (IPA [n = 320], control [n = 526]; open [n = 157], closed fractures [n = 689]) who underwent orthopaedic fracture care. Among SSIs, 28 (48%) patients received IPA prophylaxis and 25 (42%) of the fractures were open.Intervention:Intrawound powdered vancomycin and tobramycinMain Outcome Measurements:Distribution of bacterial species and resistance patterns causing deep surgical site infections requiring operative debridement.Results:Zero patients developed infections caused by resistant strains of streptococci, enterococci, gram-negative enterics, Pseudomonas, or Cutibacterium species. The only resistant strains isolated were methicillin resistance (19%) and oxacillin-resistant coagulase-negative staphylococci (16%). There was no associated statistical difference in the proportion of bacterial species isolated, their resistance profiles, or rate of polymicrobial infections between the IPA and control group. Most (93%) cases using IPAs included vancomycin and tobramycin powders. There were 59 SSIs; 28 (9%) in the IPA cohort and 31 (6%) in the control cohort (P = 0.13).Conclusion:The use of local antibiotic prophylaxis resulted in no measurable increase in the proportion of infections caused by resistant bacterial pathogens after operative treatment of fractures. However, the small sample size and limited time frame of these preliminary data require continued investigation into their role as an adjunct to SSI prophylaxis.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
KW - bacterial resistance
KW - local antibiotics
KW - powdered antibiotics
KW - surgical site infection
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U2 - 10.1097/BOT.0000000000002595
DO - 10.1097/BOT.0000000000002595
M3 - Article
C2 - 36920373
AN - SCOPUS:85164844787
SN - 0890-5339
VL - 37
SP - 386
EP - 392
JO - Journal of orthopaedic trauma
JF - Journal of orthopaedic trauma
IS - 8
ER -