Systemic Absorption and Nephrotoxicity Associated With Topic
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A Study was conducted to determine whether using topical vancomycin powder in fracture surgery may result in low levels of vancomycin in the serum and not result in nephrotoxicity. 58 patients were involved with tibial plateau and pilon fractures randomized to the treatment arm at the principal investigator's site.

Topical vancomycin powder (1000 mg) was applied directly in the wound over all metal implants at the time of wound closure.

Serum vancomycin levels at 1 hour and 6–8 hours after surgery were assessed. Secondary outcomes included serum creatinine before surgery, a day after surgery, and at 2 weeks postoperatively and complete blood count at 2 weeks postoperatively.

Results:
Except in 2 patients who also received IV vancomycin, none of the study patients had detectable (more than 5 µg/mL) serum vancomycin levels at 1 hour and 6–8 hours after surgery. One patient with a history of elevation of serum creatinine had a minor increase of serum creatinine but had undetectable vancomycin levels. None of the other patients had a clinically significant increase in creatinine levels.

These prospective data indicate that there seems to be little clinical concern regarding toxicity associated with systemic absorption of vancomycin powder in this specific clinical application.

Source: https://journals.lww.com/jorthotrauma/Abstract/2021/01000/Systemic_Absorption_and_Nephrotoxicity_Associated.7.aspx
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