Elizabeth Hofheinz, M.P.H., M.Ed.
Citing a study indicating that Staphylococcus aureus is the most frequent organism encountered in fracture surgery and has been implicated in 56% of surgical site infections after fracture surgery,1 a team from the R Adams Cowley Shock Trauma Center set out to see if application of topical vancomycin powder in fracture surgery patients with surgical site infections have a lower proportion of Staphylococcus aureus infections than patients who did not receive topical vancomycin powder.
Their work, “Topical Vancomycin Powder Decreases the Proportion of Staphylococcus aureus Found in Culture of Surgical Site Infections in Operatively Treated Fractures,” appears in the January 2021 edition of the Journal of Orthopaedic Trauma.
Robert O’Toole, M.D., Division Head of Orthopaedic Traumatology at R Adams Cowley Shock Trauma Center at the University of Maryland School of Medicine in Baltimore, was a co-author on this work. Dr. O’Toole told OSN, “We, and other centers, were using topical vancomycin powder in attempt to reduce deep surgical site infection after fracture surgery. It was known that vancomycin only has activity against gram positive bacteria. Therefore, it was possible that use of topical vancomycin would change the type of bacteria in the wound. This could occur because it reduced the risk of deep surgical site infection by gram positive bacteria or just by changing the observed bacteria without changing the overall infection rate.”
On the hunt for deep infections, the researchers conducted a retrospective analysis of all orthopaedic surgeries performed by the Shock trauma division from January 2011 to February 2015. Included in the analysis were all deep infections treated with surgical debridement after pelvic and extremity fracture and tibial and femoral nonunion surgeries.
A total of 133 patients (145 injuries) had complete data and a minimum of 6 months of postop follow-up and were included for analysis. Ten of the 133 patients who received vancomycin powder developed deep surgical site infection.
“The group with vancomycin appeared to have fewer staph aureus infections,” said Dr. O’Toole to OSN. “This work implies that vancomycin powder may be doing something. At the least it is changing the bacterial profile, and hopefully it is causing the observed change by reducing the proportion of patients who become infected with staph aureus. Subsequent to this study the VANCO trial (randomized controlled multicenter study by the Major Extremity Trauma Research Consortium) answered this question if vancomycin powder actually reduced gram positive infections.”
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