title: Serum and Wound Vancomycin Levels After Intrawound Administration in Primary Total Joint Arthroplasty.
abstract: Periprosthetic joint infection is the most common cause of readmissions after total joint arthroplasty (TJA). Intrawound vancomycin powder (VP) has reduced infection rates in spine surgery; however, there are no data regarding VP in primary TJA.
  
  
  
  Thirty-four TJA patients received 2 g of VP intraoperatively to investigate VP's pharmacokinetics. Serum and wound concentrations were measured at multiple intervals over 24 hours after closure.
  
  
  
  All serum concentrations were subtherapeutic (<15μg/mL) and peaked 12 hours after closure (4.7μg/mL; standard deviation [SD], 3.2). Wound concentrations were 922 μg/mL (SD, 523) 3 hours after closure and 207 μg/mL (SD, 317) at 24 hours. VP had a half-life of 7.2 hours (95% confidence interval, 7.0-9.3) in TJA wounds.
  
  
  
  VP produced highly therapeutic intrawound concentrations while yielding low systemic levels in TJA. VP may serve as a safe adjunct in the prevention of periprosthetic joint infection.
authors.affiliation: Department of Orthopaedic Surgery, Regions Hospital, St. Paul, Minnesota; Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Jeremiah D
authors.initials: JD
authors.lastname: Johnson
authors.affiliation: Creighton University School of Medicine, Omaha, Nebraska.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Nessler
authors.affiliation: Department of Orthopaedic Surgery, Regions Hospital, St. Paul, Minnesota; Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Ryan D
authors.initials: RD
authors.lastname: Horazdovsky
authors.affiliation: Department of Orthopaedic Surgery, Regions Hospital, St. Paul, Minnesota; Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Sandy
authors.initials: S
authors.lastname: Vang
authors.affiliation: HealthPartners Institute for Education and Research, Bloomington, Minnesota.
authors.forename: Avis J
authors.initials: AJ
authors.lastname: Thomas
authors.affiliation: Department of Orthopaedic Surgery, Regions Hospital, St. Paul, Minnesota; Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Scott B
authors.initials: SB
authors.lastname: Marston
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000097:blood / Q000493:pharmacokinetics; D001170:Arthritis, Infectious; D001178:Arthroplasty / Q000009:adverse effects; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D005260:Female; D006207:Half-Life; D006801:Humans; D008297:Male; D008875:Middle Aged; D011208:Powders; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000517:prevention & control*; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control; D014640:Vancomycin / Q000008:administration & dosage* / Q000097:blood / Q000493:pharmacokinetics
chemical_list: D000900:Anti-Bacterial Agents; D011208:Powders; D014640:Vancomycin
keywords: intrawound vancomycin concentration; periprosthetic infection; primary total joint arthroplasty; prophylactic vancomycin; serum vancomycin concentration; topical vancomycin