title: Complications associated with bacitracin powder in surgical wounds.
abstract: OBJECTIVE
  There has been renewed interest in the application of concentrated antibiotic powder to surgical wounds as a method to decrease infection rates. While there is substantial medical literature describing the effectiveness and complications associated with vancomycin and gentamycin powders, very little has been reported regarding the safety and effectiveness of bacitracin powder in surgical wounds. In this paper the authors report their detailed analysis of potential bacitracin powder-related complications in a population of pediatric patients who underwent shunt surgery.
  
  
  METHODS
  A detailed retrospective analysis was completed of all CSF shunt surgeries performed by the corresponding author at a large children's hospital between 2001 and 2013. This cohort consisted of many patients who were the subject of a previous report that showed the use of bacitracin powder in shunt wounds potentially decreased infection rates. Data were collected regarding the most common known complications of bacitracin, i.e., anaphylaxis, wound healing difficulties, and renal dysfunction. Data were stratified by typical demographic, medical, and surgical variables, including whether bacitracin powder was applied to wounds prior to closure.
  
  
  RESULTS
  A total of 597 patients were reviewed in the analysis: 389 underwent surgery without bacitracin powder and 208 had concentrated bacitracin powder applied to the wounds prior to closure. The application of bacitracin powder was not associated with anaphylaxis (n = 0 both groups) or with an increase in wound breakdown (n = 5 in the control group, n = 0 in the bacitracin powder group) or renal dysfunction (creatinine/estimated glomerular filtration rate) using both comparative and multivariate analyses between the 2 groups. The sample size evaluating renal function was significantly lower (range 6-320) than that of anaphylaxis and wound breakdown analysis because only clinical values acquired during the routine care of these patients were available for analysis. The only significant difference in demographics was the more frequent use of intrathecal vancomycin and gentamycin in patients who received bacitracin powder (n = 1 for controls, n = 21 for bacitracin powder). In the multivariate analysis, only 1 factor, surgery performed on a premature infant within the first 3 months of life, was independently associated with a change in creatinine at 3 months (creatinine decreased by 0.18) compared with the level before surgery (p < 0.0001). Bacitracin powder was not a significant factor.
  
  
  CONCLUSIONS
  To the authors' knowledge, this is the first study to systematically analyze the potential complications of concentrated bacitracin powder applied to surgical wounds. The use of topical bacitracin powder in CSF shunt wounds was not associated with anaphylaxis, wound breakdown, or renal dysfunction. Further study using standardized protocols is necessary before widespread use can be recommended.
authors.affiliation: Department of Neurosurgery and Brain Repair and.
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Beckman
authors.affiliation: Department of Clinical and Translational Research, and.|Department of Pediatrics, Johns Hopkins Medicine, Baltimore, Maryland.
authors.forename: Ernest K
authors.initials: EK
authors.lastname: Amankwah
authors.affiliation: Department of Clinical and Translational Research, and.|Neuroscience Institute, All Children's Hospital/Johns Hopkins Medicine, St. Petersburg, Florida; and.
authors.forename: Lisa L
authors.initials: LL
authors.lastname: Tetreault
authors.affiliation: Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, Florida;
authors.forename: Sharon A
authors.initials: SA
authors.lastname: Perlman
authors.affiliation: Department of Neurosurgery and Brain Repair and.|Neuroscience Institute, All Children's Hospital/Johns Hopkins Medicine, St. Petersburg, Florida; and.|Department of Pediatrics, Johns Hopkins Medicine, Baltimore, Maryland.
authors.forename: Gerald F
authors.initials: GF
authors.lastname: Tuite
mesh_terms: D000293:Adolescent; D000707:Anaphylaxis / Q000139:chemically induced; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage / Q000009:adverse effects*; D019072:Antibiotic Prophylaxis / Q000009:adverse effects* / Q000379:methods; D001414:Bacitracin / Q000008:administration & dosage / Q000009:adverse effects*; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery; D007223:Infant; D007278:Injections, Spinal; D008297:Male; D008499:Medical Records; D011208:Powders; D051437:Renal Insufficiency / Q000139:chemically induced; D012189:Retrospective Studies; D012307:Risk Factors; D013529:Surgical Wound Dehiscence / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome; D014640:Vancomycin / Q000008:administration & dosage; D014945:Wound Healing / Q000187:drug effects
chemical_list: D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D005839:Gentamicins; D011208:Powders; D001414:Bacitracin; D014640:Vancomycin
keywords: HR = hazard ratio; antibiotic; bacitracin; cerebrospinal; eGFR = estimated glomerular filtration rate; hydrocephalus; infection; powder