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Intrawound Antibiotic Powder in Acetabular Fracture Open Reduction Internal Fixation Does Not Reduce Surgical Site Infections.

Abstract：

OBJECTIVES:To compare the risks of surgical site infection (SSI) and postoperative complications after acetabular fracture open reduction internal fixation (ORIF) in patients receiving topical intrawound antibiotic powder compared to those not receiving antibiotic powder (control group). DESIGN:Retrospective cohort SETTING:: Level I trauma center PATIENTS AND INTERVENTION:: We reviewed 789 acetabular fracture ORIF cases from 2010-2019 at our institution, with mean follow-up 18 months (3-112 months). Overall, 326 patients comprised the control group and 463 received topical antibiotic powder (294 vancomycin and 169 vancomycin/tobramycin). MAIN OUTCOME MEASUREMENT:The study groups were compared for risk of SSI, seroma formation, wound dehiscence, acute kidney injury (AKI) and other post-operative complications. RESULTS:There were 63 total SSI (8.0%), 50 (6.3%) deep SSI and 13 suprafascial SSI (1.6%) cases. There was no difference in the risk of total SSI (8.3% vs 7.8%, p=0.80) or deep SSI (6.1% vs 6.5%, p=0.64). This was confirmed by multivariate analysis adjusting for covariates (OR=0.93; 95% CI, 0.52-1.67; p=0.80). Similar results were demonstrated when comparing the control group to the vancomycin and vancomycin/tobramycin subgroups. The control group and antibiotic powder groups had similar risks of all outcomes of interest, including seroma formation (1.8% vs 1.7%, p=1.00), wound dehiscence (1.2% vs 2.2%, p=0.42), total AKI (5.2% vs 8.2%, p=0.12), and RIFLE classification AKI (Injury; 0.9% vs 2.2%, p=0.50). CONCLUSIONS:The addition of topical intrawound antibiotic powder, whether vancomycin alone or vancomycin/tobramycin prior to closure, does not reduce the risk of SSI after acetabular fracture ORIF compared to standard normal saline irrigation alone. LEVEL OF EVIDENCE:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

journal_name

J Orthop Trauma

journal_title

Journal of orthopaedic trauma

authors

Cichos KH,Spitler CA,Quade JH,Ponce BA,McGwin G Jr,Ghanem ES

doi

10.1097/BOT.0000000000001943

subject

Has Abstract

pub_date

2020-09-02 00:00:00

eissn

0890-5339

issn

1531-2291

pub_type

杂志文章

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Intrawound Antibiotic Powder in Acetabular Fracture Open Reduction Internal Fixation Does Not Reduce Surgical Site Infections.