Effect of Intrawound Vancomycin powder in operatively treate
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The findings of this JAMA Surgery study suggest that intrawound vancomycin powder is a promising low-cost, low-risk intervention for reducing deep surgical site infections, particularly those with gram-positive organisms.

The study was aimed to examine the effect of intrawound vancomycin powder in reducing deep surgical site infections.

This open-label randomized clinical trial enrolled adult patients with an operatively treated tibial plateau or pilon fracture who met the criteria for a high risk of infection, with 12 months of follow-up at 36 US trauma centers.

The analysis included 980 patients with 91% of the expected person-time of follow-up for the primary outcome.

--Within 182 days, deep surgical site infection was observed in 29 of 481 patients in the treatment group and 46 of 499 patients in the control group.

--The time-to-event estimated probability of deep infection by 182 days was 6.4% in the treatment group and 9.8% in the control group.

--A post hoc analysis of the effect of treatment on gram-positive and gram-negative-only infections found that the effect of vancomycin powder as a result of its reduction in gram-positive infections.

In conclusion, among patients with operatively treated tibial articular fractures at a high risk of infection, intrawound vancomycin powder at the time of definitive fracture fixation reduced the risk of a gram-positive deep surgical site infection, consistent with the activity of vancomycin.

Source: https://jamanetwork.com/journals/jamasurgery/article-abstract/2777798
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