Intraoperative Vancomycin Powder Reduces Staphylococcus aureus Surgical Site Infections and Biofilm Formation on Fixation Implants in a Rabbit Model.

OBJECTIVES

To evaluate the effectiveness of intraoperative vancomycin powder in prevention of surgical site infection and biofilm formation on implants in a contaminated animal fixation model.

METHODS

We created a rabbit surgical model including fixation implants at a tibial surgical site seeded with methicillin-resistant Staphylococcus aureus. Our study cohort included 18 rabbits. Nine received vancomycin powder at the surgical site, and the other 9 did not. Serum vancomycin levels were measured at scheduled time points over 24 hours. Bone infection and implant biofilm formation were determined based on the number of colony-forming units present 2 weeks after surgery. Radiography, histology, and electron microscopy aided in evaluation.

RESULTS

No bone infection or implant colonization occurred in the vancomycin powder group. Six bone infections and 6 implant biofilm formations (67%; 95% confidence interval, 45%-88%) occurred in the group that did not receive vancomycin powder (P = 0.009). Serum vancomycin levels were detectable at minimal levels at 1 and 6 hours only. Pathological changes occurred in the specimens that were positive for infection.

CONCLUSIONS

Intraoperative vancomycin powder application at the time of fixation decreases risk for bone infection and biofilm formation on implants in a rabbit model, with minimal increase in serum vancomycin levels. The results are encouraging and support the rationale for a clinical trial investigating the use of local vancomycin powder to reduce the rate of surgical site infections.

CLINICAL RELEVANCE: Infection is a common complication of surgery, especially with implants. Simple methods to prevent or decrease the occurrence of infection would benefit the patient and the health care system.