ArticleBone & joint open2022
Does cumulative topical antibiotic powder use increase the risk of drug induced acute kidney injury in fracture patients?
Article in Bone & joint open, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 3 of them syntheses that pooled it.
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Who cites it
11 citing papers in PubMed, 3 syntheses or guidelines pooled it, 8 citations in OpenAlex.
- Efficacy of topical vancomycin in preventing surgical site infection following fracture surgery : a systematic review and meta-analysis.Bone & joint open · 2026Pooled it
- Conflict wounds and antimicrobial resistance: a systematic review on local antimicrobials to prevent infection after extremity open fracture.BMJ military health · 2026Pooled it
- Topical antibiotic powder reduces fracture-related infections in pelvic and lower limb fractures: a systematic review and meta-analysis.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2026Pooled it
- Trial
- Intrawound Vancomycin Powder in Surgical Site Infection Prophylaxis: A Comprehensive Review of Mechanisms, Efficacy, Safety, and Clinical Controversies.Advances in therapy · 2026Review
- Antimicrobial-laden PerOssal beads display in vitro inhibition and killing of extensively drug-resistant Gram-negative bacteria associated with conflict wounds in Ukraine.Bone & joint research · 2026Article
- Article
- Safety of locally applied antibiotics in orthopaedic trauma surgery: descriptive results from a prospective cohort study.Journal of bone and joint infection · 2026Article
- Orthopaedic infections: novel treatment strategies and evolving concepts.OTA international : the open access journal of orthopaedic trauma · 2025Article
- A technique for introducing broad-spectrum topical antibiotics during open reduction and internal fixation of acetabular fractures.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2024Article
- Orthopaedic infections: what have we learned?OTA international : the open access journal of orthopaedic trauma · 2023Review
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Authors and funding
9 authors at 2 institutions in 2 countries.
Funding
Abstract
aimsThere is increasing evidence to support the use of topical antibiotics to prevent surgical site infections. Although previous research suggests a minimal nephrotoxic risk with a single dose of vancomycin powder, fracture patients often require multiple procedures and receive additional doses of topical antibiotics. We aimed to determine if cumulative doses of intrawound vancomycin or tobramycin powder for infection prophylaxis increased the risk of drug-induced acute kidney injury (AKI) among fracture patients.
methodsThis cohort study was a secondary analysis of single-centre Program of Randomized Trials to Evaluate Pre-operative Antiseptic Skin Solutions in Orthopaedic Trauma (PREP-IT) trial data. We included patients with a surgically treated appendicular fracture. The primary outcome was drug-induced AKI. The odds of AKI per gram of vancomycin or tobramycin powder were calculated using Bayesian regression models, which adjusted for measured confounders and accounted for the interactive effects of vancomycin and tobramycin.
resultsOf the 782 included patients (mean age 48 years (SD 20); 59% male), 83% (n = 648) received at least one vancomycin dose (cumulative range 1 to 12 g). Overall, 45% of the sample received at least one tobramycin dose (cumulative range 1.2 to 9.6 g). Drug-induced AKI occurred in ten patients (1.2%). No association was found between the cumulative dose of vancomycin and drug-induced AKI (odds ratio (OR) 1.08 (95% credible interval (CrI) 0.52 to 2.14)). Additional doses of tobramycin were associated with a three-fold increase in the adjusted odds of drug-induced AKI (OR 3.66 (95% CrI 1.71 to 8.49)). Specifically, the risk of drug-induced AKI rose substantially after 4.8 g of tobramycin powder (7.5% (95% CrI 1.0 to 35.3)).
conclusionCumulative doses of vancomycin were not associated with an increased risk of drug-induced AKI among fracture patients. While the risk of drug-induced AKI remains less than 4% with three or fewer 1.2 g tobramycin doses, the estimated risk increases substantially to 8% after four cumulative doses. Level of evidence: Therapeutic Level III Cite this article:
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