Local Antibiotic Therapy to Reduce Infection After Operative Treatment of Fractures at High Risk of Infection: A Multicenter, Randomized, Controlled Trial (VANCO Study).
A number of clinical studies in the spine literature suggest that the use of local vancomycin powder may substantially reduce surgical site infections (SSIs). These studies are primarily retrospective and observational and few focus on orthopaedic trauma patients. This study is a phase III, prospective, randomized, clinical trial to assess the efficacy of locally administered vancomycin powder in the prevention of SSI after fracture surgery. The primary goal of the VANCO Study is to compare the proportion of deep SSI 6 months after fracture fixation surgery. A secondary objective is to compare species and antibacterial susceptibilities among study patients who develop SSI. An additional objective is to build and validate a risk prediction model for the development of SSI. The study population consists of patients aged 18-80 years with tibial plateau or pilon (tibial plafond) fractures, at higher risk of infection, and definitively treated with plate and screw fixation. Participants are block randomized (within center) in a 1:1 ratio to either treatment group (local vancomycin powder up to a maximum dose of 1000 mg, placed immediately before wound closure) or control group (standard of care) for each study injury location, and return to the clinic for evaluations at 2 weeks, 3 months, and 6 months after fixation. The targeted sample size for the study is 500 fractures per study arm. This study should provide important information regarding the use of local vancomycin powder during the definitive treatment of lower extremity fractures and has the potential to significantly reduce the incidence of infection after orthopaedic trauma.
*Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD; †Division of Infectious Diseases, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD; ‡Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; §U.S. Army, Uniformed Services University of the Health Sciences; San Antonio Military Medical Center, Infectious Disease Service, San Antonio, TX; ‖Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; ¶Department of Orthopaedic Surgery, McGovern Medical School at UTHealth Houston, Houston, TX; and **Carolinas Medical Center, Department of Orthopaedic Surgery, Charlotte, NC.
Robert V
RV
OʼToole
Manjari
M
Joshi
Anthony R
AR
Carlini
Clinton K
CK
Murray
Lauren E
LE
Allen
Daniel O
DO
Scharfstein
Joshua L
JL
Gary
Michael J
MJ
Bosse
Renan C
RC
Castillo
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data; D001424:Bacterial Infections / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D005592:Fracture Fixation / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000517:prevention & control*; D013978:Tibial Fractures / Q000453:epidemiology* / Q000601:surgery*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014640:Vancomycin / Q000008:administration & dosage*; D055815:Young Adult
D000900:Anti-Bacterial Agents; D014640:Vancomycin