Effect of Topical Vancomycin on Surgical Site Infections in Ankle Fractures: A Randomized, Double-Blind, Controlled Trial

TL;DR

A clinical trial found no significant difference in infection rates when using topical vancomycin for ankle fracture surgeries.

Contribution

This study is the first to evaluate topical vancomycin's effectiveness in preventing SSIs in ankle fracture surgeries with internal fixation.

Findings

Topical vancomycin showed no significant reduction in surgical site infections compared to standard treatment.

Infection rates were 3.3% in the vancomycin group and 3.5% in the control group at three months.

No infections were observed in either group by the three-month follow-up.

Abstract

Background

Applying topical vancomycin has shown a decrease in the likelihood of surgical site infections (SSIs) in surgeries linked to a heightened risk of severe and resistant infections. Nevertheless, the effectiveness of this prophylactic approach has not been assessed in open ankle surgeries with internal fixation.

Objective

This study aimed to assess whether topical vancomycin diminishes the risk of SSI in patients with ankle fractures undergoing open reduction with internal fixation.

Methods

A randomized, controlled, double-blind clinical trial was carried out. Patients were divided into two groups in a 1:1 ratio. The control group received the standard prophylactic treatment with IV cephalothin 1 g, while the intervention group was administered topical vancomycin (1 g) in addition to the standard prophylactic treatment. The main outcomes were the SSI rates at 14 days, 28 days, and three months post-surgery, based on relevant clinical signs and laboratory tests.

Results

One hundred thirty-two patients were randomized (51.2% female), with 66 subjects included in each intervention arm. A total of 97.7% of them completed the study. Both groups were homogeneous in baseline characteristics. There were two SSIs in both the vancomycin group (3.3%) and the control group (3.5%), with no statistical differences (p = 0.945). The microorganisms isolated as causal agents were Staphylococcus aureus and Acinetobacter baumannii. By the three-month follow-up, no infections were noted in both intervention groups.

Conclusion

These results indicate that the topical administration of vancomycin may not represent an advantage in preventing SSI in ankle fractures requiring open reduction with internal fixation at the three-month postoperative stage.

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