• Rabah Qadir, Timothy Costales, Max Coale, Timothy Zerhusen, Manjari Joshi, and Robert V O'Toole.
• Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD; and.
• J Orthop Trauma. 2021 Jan 1; 35 (1): 17-22.

ObjectivesTo determine whether patients with operatively treated fractures and surgical site infection after use of topical vancomycin powder have a lower proportion of Staphylococcus aureus infections than patients who did not receive topical vancomycin powder.DesignRetrospective cohort study.SettingLevel I trauma center.PatientsTreatment group: 10 of 133 patients (145 fractures) with surgical site infections who received intrawound vancomycin powder at the time of wound closure for fracture fixation. Control group: 175 patients who sustained deep surgical site infections during the same period but did not receive vancomycin powder.InterventionVancomycin powder or no vancomycin powder.Main Outcome MeasurementProportion of patients' cultures positive for S. aureus.ResultsThe proportion of cultures positive for S. aureus was significantly lower in patients with surgical site infection who received vancomycin powder than in those who did not receive vancomycin powder (10% [1 of 10 patients in the treatment group] vs. 50% [87 of 175 patients in the control group]; P = 0.02). A trend was observed for a lower proportion of methicillin-resistant S. aureus (0% vs. 23%; P = 0.12).ConclusionsVancomycin powder might alter the bacteriology of surgical site infections and decrease the proportion in culture of the most common organism typically present after fracture surgery infection. These findings suggest that the application of vancomycin powder might change the bacteriology of surgical site infections when they occur, regardless of the effect on overall infection rates. Although our bacteriology results are clinically and statistically significant, these findings must be confirmed in larger randomized controlled trials.Level Of EvidenceTherapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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