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Intrasite Antibiotic Powder for the Prevention of Surgical Site Infection in Extremity Surgery

A Systematic Review

Fernicola, Stephen D. MD; Elsenbeck, Michael J. MD; Grimm, Patrick D. MD; Pisano, Alfred J. MD; Wagner, Scott C. MD

Journal of the American Academy of Orthopaedic Surgeons: April 16, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.5435/JAAOS-D-18-00475
Research Article: PDF Only

Introduction: Although the role of intrasite antibiotic powder in preventing surgical site infections (SSIs) has been extensively explored in spinal surgery, it remains underevaluated in the other orthopaedic subspecialties. This systematic review examines the utilization of intrawound antibiotic powder as a prophylactic measure against SSIs in orthopaedic procedures.

Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, electronic searches were conducted on Ovid MEDLINE, and PubMed. Only English language, nonspine clinical studies published before May 2018 were included.

Results: The initial search identified 179 individual citations, and 11 studies met the eligibility criteria. All included studies were level III retrospective studies. Represented subspecialties included total joint arthroplasty, upper extremity, foot and ankle, and trauma. Eight studies demonstrated a statistically significant decrease in SSIs with the use of intrasite antibiotic powder.

Discussion: There are no current guidelines for the use of intrasite antibiotic powder for the prevention of SSIs in orthopaedic procedures. Despite the lack of high-quality evidence available in the literature, published smaller studies do suggest a significant protective effect. However, recommendations with regard to this technique after common orthopaedic procedures cannot yet be made.

From the Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MA.

Correspondence to Dr. Wagner:

None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Fernicola, Dr. Elsenbeck, Dr. Grimm, Dr. Pisano, and Dr. Wagner.

The views expressed in this article are those of the authors and do not reflect the official policy of the Department of Navy, Department of Army, Department of Defense, or US Government. The authors are employees of the US Government. This work was prepared as part of their official duties, and as such, there is no copyright to be transferred.

© 2019 by American Academy of Orthopaedic Surgeons
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