Objective:
Evaluate the species distribution and resistance patterns of bacterial pathogens causing surgical site infection (SSI) after operative fracture repair, with and without the use of intrawound powdered antibiotic (IPA) prophylaxis during the index surgery.
Design:
Retrospective cohort study.
Setting:
Academic, level 1 trauma center, 2018-2020.
Patients/Participants: 59 deep SSIs were identified in a sample of 734 patients with 846 fractures (IPA [n=320], control [n=526]; open [n=157], closed fractures [n=689]) who underwent orthopaedic fracture care. Among SSIs, 28 (48%) patients received IPA prophylaxis and 25 (42%) of the fractures were open.
Intervention:
Intrawound powdered vancomycin and tobramycin
Main Outcome Measurements:
Distribution of bacterial species and resistance patterns causing deep surgical site infections requiring operative debridement.
Results:
Zero patients developed infections caused by resistant strains of streptococci, enterococci, gram-negative enterics, Pseudomonas, or Cutibacterium species. The only resistant strains isolated were MRSA (19%) and oxacillin-resistant coagulase-negative staphylococci (16%). There was no associated statistical difference in the proportion of bacterial species isolated, their resistance profiles, or rate of polymicrobial infections between the IPA and control group. The vast majority (93%) of cases using IPAs included both vancomycin and tobramycin powders. There were 59 SSIs; 28 (9%) in the IPA cohort and 31 (6%) in the control cohort (p=0.13).
Conclusion:
The use of local antibiotic prophylaxis resulted in no measurable increase in the proportion of infections caused by resistant bacterial pathogens after operative treatment of fractures. However, the small sample size and limited time frame of these preliminary data require continued investigation into their role as an adjunct to SSI prophylaxis.
