Prophylactic Topical Antibiotics in Fracture Repair and Spinal Fusion

Table 2

Summary of infection rates and methodology of studies of fracture repair.

Authors/year	Study design/method of controlling for bias	No. of pts	Age range of pts	Diagnosis	Intervention	Wound infection rates in treatment group	Wound infection rates in control group
Bibbo and Patel 2006 [50]	PC/NR	44	17–59	Calcaneal fractures	Vancomycin/DBM-calcium sulfate bone graft substitute	0% (0/33)	0% (0/11)
Cichos et al. 2021 [51]^a	RC/multivariate analysis	789	18–89	Acetabular fractures	Vancomycin powder 1 g; Vancomycin 1 g and tobramycin 1.2 g	Vancomycin: 6.80% (20/294, 18 deep, 2 suprafascial); Vancomycin and tobramycin 9.47% (16/169, 12 deep, 4 suprafascial)	8.28% (27/326, 20 deep, 7 suprafascial)
Junker et al. 2019 [52]	PC/NR	285	18 or above	Rib fractures	Vancomycin 2 g and gentamicin 2.4 g PMMA	0% (0/8)	3.61% (10/277)
Keating et al. 1996 [53]^‡	RC/NR	79 (79 patients, 81 fractures)	16–88	Open tibial fractures	2.4 g Tobramycin-loaded pouch	3.77% (2/55)	16.0% (4/26)
Lawing et al. 2015 [54]	RC/logistic regression	351	“Excluded kids <10”	Open fractures	Aminoglycosides 2 mg/mL	9.52% (16/168, 10 deep, 6 superficial)	19.67% (36/183, 26 deep, 10 superficial)
Malizos et al. 2017 [55]	RCT/randomization	253	20–99	Closed fractures	Antibiotic-loaded hydrogel 20–50 mg/mL	0% (0/126)	4.72% (6/127)
Moehring et al. 2000 [56]^‡,b	RCT/randomization	55 (treatment: 22 patients, 24 fractures; Control: 33 patients, 38 fractures)	16–76	Open fractures (primarily lower extremity)	2.4 g tobramycin-impregnated beads	9.09% (2/22)	6.06% (2/33)
O’Toole et al. 2021 [57]^,c	RCT/randomization	980	“Adult patients”	Tibial plateau and pilon fractures	Vancomycin powder 1 g	6.03% (29/481)	9.22% (46/499)
Ostermann et al. 1995 [58]	PC/NR	914 (1085 fractures)	14–99	Open fractures (primarily lower extremity)	Tobramycin-PMMA	3.67% (31/845)	12.08% (29/240)
Owen et al. 2017 [59]^‡,	RC/stratification, logistic regression	140	19–65	Pelvic and acetabular fractures	Vancomycin 1 g and tobramycin 1.2 g powder	4.23% (3/71)	14.49% (10/69)
Prevost et al. 2019 [60]^‡	RC/NR	90	NR	Open tibial fractures	Vancomycin and tobramycin powder	16.67% (11/66)	25.0% (6/24)
Qadir et al. 2020 [61]^,‡,d	RC/propensity-score matching, nearest-neighbor matching	105	16–85	Bicondylar tibial plateau, tibial pilon, and calcaneus fractures	Vancomycin powder 1 g	0% (0/35)	14.29% (10/70)
Singh et al. 2015 [62]^‡	RC/NR	93	“Adults”	Tibial plateau and pilon fractures	Vancomycin 1 g	10.00% (1/10)	16.87% (14/83)
Vaida et al. 2019 [63]^‡	RC/NR	457	NR	Open lower extremity fractures	Vancomycin powder	8.51% (4/47)	8.78% (36/410)

Abbreviations: No., number; pts, patients; RCT, randomized controlled trial; PC, prospective cohort; RC, retrospective cohort; NR, not reported; DBM, demineralized bone matrix; PMMA, polymethyl methacrylate. ^aWe combined the two treatment groups into one intervention group in our analysis. ^bThe treatment group received just antibiotic beads, and the control group received just parenteral antibiotics. Not included are the nonrandomized third cohort that received antibiotic beads + IV. This group of patients all had Grade 3 Gustilo–Anderson open fractures. ^cWe included only deep SSI, which was the primary study outcome. Superficial SSI was excluded because the sample sizes for superficial SSI did not match those for deep SSI. ^dThis study conducted analyses using two separate methods of matching: nearest-neighbor matching and propensity score matching. It also had both prospective and retrospective control cohorts. We included the data from propensity scores matching with the prospective control cohort. ^‡Only deep infections were reported in this study. Studies showed a significant difference between the control and treatment groups.