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

Abstract

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