Effectiveness and safety of vancomycin powder injection locally applied in theprevention of prosthetic joint infection

Abstract

Prosthetic joint infection is a rare but serious complication that is associated with considerable morbidity and financialburdens and other hardships for the individual. The available treatment options for PJI include both surgery andantimicrobial therapy. The surgical option includes debridement, antibiotics and implant retention (DAIR), that is usuallyrecommended at initial stages, one stage or two stage revision arthroplasty at advanced stages. These treatments are muchexpensive and time consuming and have around 11-30% failure rate. Therefore, there is an urgent need for a appropriate andaffordable treatment strategy. Vancomycin serves as an active agent against the pathogens that have ability to causepotential damage to the wounds after surgery. In its powder form, it ensures adequate surgical site concentrations whileminimizing the adverse effects caused by undetectable systemic distribution. Thus, we explored the effectiveness and safetyof vancomycin powder injection locally applied in the prevention of prosthetic joint infection (PJI). A total of 90 inpatientswho underwent total hip and knee arthroplasty from January 2018 to December 2019 were selected and randomly dividedinto control group (routine preventive antibiotic therapy) and treatment group (vancomycin applied based on the treatmentof control group). The incidence of PJI and adverse reactions within 3 months after operation was observed. The changes inbody temperature, neutrophil count, interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hs-CRP) levels wererecorded before operation and 1, 3 and 7 days after treatment. Ninety days after treatment, the incidence rate of PJI intreatment group (0.00) was significantly lower than that of control group (8.89%) (P <0.05). Within a short period of time (1d and 3 d) after treatment, the body temperature, neutrophil count, IL-6 and hs-CRP levels were all lower in treatment groupthan those in control group (P <0.05). However, the above indices had no significant differences between the two groups at1 week (7 d) after treatment (P >0.05). There were 3 cases (6.67%) and 2 cases (4.44%) of adverse reactions in treatmentgroup and control group, respectively. The incidence rates of adverse reactions were similar (χ2=0.212, P=0.645).Vancomycin powder injection locally applied can control the body temperature, and reduce the neutrophil count, IL-6 andhs-CRP levels within a short period of time after operation, which is superior to routine preventive antibiotic therapy. It candecrease the incidence rate of PJI after arthroplasty.