Page 82 - 2022 Spring JSOM

Further research must be done to demonstrate vancomycin’s a strategy to prevent biofilm formation and infections. OTA Int.
efficacy in open penetrating trauma wounds. The research has 2020;3(4):e091.
begun at various levels and will continue as long as successes 13. Penn-Barwell JG, Murray CK, Wenke JC. Early antibiotics and
in the realm of surgical prophylaxis continues. The Place- debridement independently reduce infection in an open fracture
model. J Bone Joint Surg Br. 2012;94(1):107–112.
ment of Antibiotic Powder in Wounds during the Emergency 14. Stoodley P, Ehrlich GD, Sedghizadeh PP, et al. Orthopaedic bio-
Room (POWDER) study is a prospective controlled study film infections. Curr Ortho Pract. 2011;22(6):558–563.
24
that recently began in October 2020. Open fracture injuries 15. Ghannoum MA, Parsek MR, Whiteley M, Mukherjee PK. Micro-
encountered in the Emergency Room will have 2g of topical bial biofilms. Washington, DC: ASM Press; 2015.
vancomycin powder applied to evaluate effectiveness of early 16. Hospenthal DR, Murray CK, Andersen RC, et al. Guidelines for
topical antibiotic intervention. Additionally, a prospective the prevention of infections associated with combat-related inju-
randomized controlled trial known as the VANCO study is ries: 2011 update: endorsed by the Infectious Diseases Society of
America and the Surgical Infection Society. J Trauma. 2011;71(2
currently underway. The intent of the VANCO study is to Suppl 2):S210–S234.
30
evaluate efficacy of prophylactic vancomycin powder use in 17. Lack WD, Karunakar MA, Angerame MR, et al. Type III open
orthopedic trauma patients. Future research should include a tibia fractures: immediate antibiotic prophylaxis minimizes in-
prospective study of the application of vancomycin powder at fection [published correction appears in J Orthop Trauma. 2015
the point of injury on the battlefield, applied by SOF combat Jun;29(6):e213]. J Orthop Trauma. 2015;29(1):1–6.
medics. The current guidelines for TCCC are critically import- 18. Brenner GM, Stevens CW. Pharmacology. Philadelphia, PA:
Saunders/Elsevier; 2013.
ant to adhere to, and this research does not intend to subtract 19. Caroom C, Moore D, Mudaliar N, et al. Intrawound vancomy-
from the CPGs. The corroboration of this data has shown that cin powder reduces bacterial load in contaminated open fracture
vancomycin powder could be a promising adjunctive agent model. J Orthop Trauma. 2018;32(10):538–541.
for preventing infection and morbidity in open penetrating 20. Gande A, Rosinski A, Cunningham T, et al. Selection pressures of
trauma wounds across the DoD. vancomycin powder use in spine surgery: a meta-analysis. Spine
J. 2019;19(6):1076–1084.
21. Olson ME, Horswill AR. Staphylococcus aureus osteomyelitis:
References bad to the bone. Cell Host Microbe. 2013;13(6):629–631.
1. Murray CK, Hsu JR, Solomkin JS, et al. Prevention and man- 22. Douthit C, Gudenkauf B, Hamood A, et al. Effects of powdered
agement of infections associated with combat-related extremity rifampin and vancomycin solutions on biofilm production of
injuries. J Trauma. 2008;64(3 Suppl):S239–S251. staphylococcus aureus on orthopedic implants. J Clin Orthop
2. Schauer SG, Fisher AD, April MD, et al. Prehospital adminis- Trauma. 2020;11(Suppl 1):S113–S117.
tration of antibiotic prophylaxis for open combat wounds in Af- 23. Schubert S, Dalhoff A. Activity of moxifloxacin, imipenem, and
ghanistan: 2013–2014. J Spec Oper Med. 2018;18(2):53–56. ertapenem against Escherichia coli, Enterobacter cloacae, En-
3. TCCC Guidelines for Medical Personnel. 1 August 2019. https:// terococcus faecalis, and Bacteroides fragilis in monocultures and
jts.amedd.army.mil/assets/docs/cpgs/Tactical_Combat_Casualty_ mixed cultures in an in vitro pharmacokinetic/pharmacodynamic
Care_Guidelines_01_Aug_2019.pdf. Accessed 6 August 2021. model simulating concentrations in the human pancreas. Anti-
4. Pavey GJ, Formby PM, Hoyt BW, et al. Intrawound antibiotic microb Agents Chemother. 2012;56(12):6434–6436.
powder decreases frequency of deep infection and severity of 24. Schauer SG, Naylor JF, Ahmed YM, et al. Prehospital combat
heterotopic ossification in combat lower extremity amputations. wound medication pack administration in Iraq and Afghanistan:
Clin Orthop Relat Res. 2019;477(4):802–810. a Department of Defense trauma registry analysis. J Spec Oper
5. Tennent DJ, Shiels SM, Sanchez CJ Jr, et al. Time-dependent ef- Med. 2020;20(3):76–80.
fectiveness of locally applied vancomycin powder in a contam- 25. Clinicaltrials.gov. Placement of antibiotic powder in wounds during
inated traumatic orthopaedic wound model. J Orthop Trauma. the emergency room – Tabular View. https://clinicaltrials.gov/ct2
2016;30(10):531–537. /show/NCT03765567. Accessed 6 August 2021.
6. Patel NN, Guild GN 3rd, Kumar AR. Intrawound vancomycin 26. Sweet FA, Roh M, Sliva C. Intrawound application of vanco-
in primary hip and knee arthroplasty: a safe and cost-effective mycin for prophylaxis in instrumented thoracolumbar fusions.
means to decrease early periprosthetic joint infection. Arthroplast Spine. 2011;36(24):2084–2088.
Today. 2018;4(4):479–483. 27. Tubaki VR, Rajasekaran S, Shetty AP. Effects of using intrave-
7. Petfield JL, Tribble DR, Potter BK, et al. Is bone loss or devas- nous antibiotic only versus local intrawound vancomycin anti-
cularization associated with recurrence of osteomyelitis in war- biotic powder application in addition to intravenous antibiotics
time open tibia fractures? Clin Orthop Relat Res. 2019;477(4): on postoperative infection in spine surgery in 907 patients. Spine
789–801. (Phila Pa 1976). 2013;38(25):2149–2155.
8. Mende K, Stewart L, Shaikh F, et al. Microbiology of combat-re- 28. Koutalos AA, Drakos A, Fyllos A, et al. Does intra-wound vanco-
lated extremity wounds: Trauma Infectious Disease Outcomes mycin powder affect the action of intra-articular tranexamic acid
Study. Diagn Microbiol Infect Dis. 2019;94(2):173–179. in total joint replacement? Microorganisms. 2020;8(5):671.
9. Tribble DR, Lewandowski LR, Potter BK, et al. Osteomyelitis 29. Kotwal RS, Howard JT, Orman JA, et al. The effect of a golden
risk factors related to combat trauma open tibia fractures: a hour policy on the morbidity and mortality of combat casualties.
case-control analysis. J Orthop Trauma. 2018;32(9):e344–e353. JAMA Surg. 2016;151(1):15.
10. Yun HC, Branstetter JG, Murray CK. Osteomyelitis in military 30. O’Toole RV, Joshi M, Carlini AR, et al. Local antibiotic ther-
personnel wounded in Iraq and Afghanistan. J Trauma. 2008;64 apy to reduce infection after operative treatment of fractures
(2 Suppl):S163–S168. at high risk of infection: a multicenter, randomized, controlled
11. López D, Vlamakis H, Kolter R. Biofilms. Cold Spring Harb Per- trial (VANCO Study) [published correction appears in J Orthop
spect Biol. 2010;2(7):a000398. Trauma. 2017 Sep;31(9):e308] [published correction appears in
12. Burbank KM, Schauer SG, De Lorenzo RA, Wenke JC. Early ap- J Orthop Trauma. 2018 May;32(5):e197]. J Orthop Trauma.
plication of topical antibiotic powder in open-fracture wounds: 2017;31 Suppl 1:S18–S24.

80 | JSOM Volume 22, Edition 1 / Sping 2022