Evidence map›Paper›PMID 41984450›Full record

Trial reportJAMA2026

Intrawound Tobramycin Plus Vancomycin to Prevent Surgical Site Infection in Tibial Fractures: The TOBRA Randomized Clinical Trial.

Major Extremity Trauma Research Consortium (METRC), Robert V O'Toole, Nathan N O'Hara, Anthony R Carlini, Gregory M Schrank, Suna Chung, Joshua L Gary, William Obremskey, Paul Edward Matuszewski, David Teague and 167 more

Registry-linked trialAbstract readClinical Trial, Phase IIIComparative StudyEquivalence Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in JAMA, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02227446 (Local Antibiotic Therapy to Reduce Infection After Operative Treatment of Fractures at High Risk of Infection), which is not on this map. Cited by 1 paper, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02227446 phase3completednot on this map

Local Antibiotic Therapy to Reduce Infection After Operative Treatment of Fractures at High Risk of Infection: A Multicenter Randomized, Controlled Trial (Vancomycin Study)

TypeinterventionalSponsorMajor Extremity Trauma Research ConsortiumRan2014 to 2019Enrolled1,036ConditionsPost Operative Surgical Site InfectionArmsVancomycin antibiotic powder
3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

177 authors.

Major Extremity Trauma Research Consortium (METRC)
Robert V O'TooleR. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore.
Nathan N O'HaraR. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore.
Anthony R CarliniJohns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Gregory M SchrankR. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore.
Suna ChungJohns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Joshua L GaryUniversity of Southern California Keck School of Medicine, Los Angeles.
William ObremskeyVanderbilt University Medical Center, Nashville, Tennessee.
Paul Edward MatuszewskiUniversity of Kentucky, Lexington.
David TeagueUniversity of Oklahoma Medical Center, Oklahoma City.
Roman M NatoliIndiana University Health Methodist Hospital, Indianapolis.
Ida Leah GitajnDartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
Michael J WeaverBrigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Christopher H RenningerWalter Reed National Military Medical Center, Bethesda, Maryland.
Ashley Elizabeth LevackLoyola University Medical Center, Maywood, Illinois.
Yasmin DeganiR. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore.
Susan C CollinsJohns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Elias Weston-FarberJohns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Andrea L HoweR. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore.
Richard E ThompsonJohns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Renan C CastilloJohns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Madhav A KarunakarAtrium Health-Carolinas Medical Center, Charlotte, North Carolina.
Laura BlumAtrium Health-Carolinas Medical Center, Charlotte, North Carolina.
Luke HarmerAtrium Health-Carolinas Medical Center, Charlotte, North Carolina.
Joseph R HsuAtrium Health-Carolinas Medical Center, Charlotte, North Carolina.
Laurence B KemptonAtrium Health-Carolinas Medical Center, Charlotte, North Carolina.
Kevin D PhelpsAtrium Health-Carolinas Medical Center, Charlotte, North Carolina.
Rachel B SeymourAtrium Health-Carolinas Medical Center, Charlotte, North Carolina.
Stephen H SimsAtrium Health-Carolinas Medical Center, Charlotte, North Carolina.
Maithili S AcharyaAtrium Health-Carolinas Medical Center, Charlotte, North Carolina.
Hayden CallahanAtrium Health-Carolinas Medical Center, Charlotte, North Carolina.
Luz M Chavez-AraujoAtrium Health-Carolinas Medical Center, Charlotte, North Carolina.
Christine ChurchillAtrium Health-Carolinas Medical Center, Charlotte, North Carolina.
Michael P GambuzzaAtrium Health-Carolinas Medical Center, Charlotte, North Carolina.
Kara R HaimAtrium Health-Carolinas Medical Center, Charlotte, North Carolina.
Enosh IshmanAtrium Health-Carolinas Medical Center, Charlotte, North Carolina.
Joshua S KendallAtrium Health-Carolinas Medical Center, Charlotte, North Carolina.
Nicholas D MullisAtrium Health-Carolinas Medical Center, Charlotte, North Carolina.
Catherine YoungAtrium Health-Carolinas Medical Center, Charlotte, North Carolina.
Holly T PilsonAtrium Health-Wake Forest Baptist, Winston-Salem, North Carolina.
Eben A CarrollAtrium Health-Wake Forest Baptist, Winston-Salem, North Carolina.
James Brett GoodmanAtrium Health-Wake Forest Baptist, Winston-Salem, North Carolina.
Martha B HoldenAtrium Health-Wake Forest Baptist, Winston-Salem, North Carolina.
Alan L JonesBaylor Scott & White Health, Dallas, Texas.
Charles MoonCedars-Sinai Medical Center, Los Angeles, California.
Carol A LinCedars-Sinai Medical Center, Los Angeles, California.
Geoffrey S MarecekCedars-Sinai Medical Center, Los Angeles, California.
Gable B MoffittCorewell Health, Grand Rapids, Michigan.
Todd ConlanCorewell Health, Grand Rapids, Michigan.
Albert V GeorgeCorewell Health, Grand Rapids, Michigan.
Lillian Adelaide FisherDartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
Devin S MullinDartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
Chelsey L RecendezDartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
Arun AnejaHarvard University, Boston, Massachusetts.
Devon T BrameierHarvard University, Boston, Massachusetts.
Marilyn HengHarvard University, Boston, Massachusetts.
Thuan V LyHarvard University, Boston, Massachusetts.
Derek S StenquistHarvard University, Boston, Massachusetts.
Nishant SunejaHarvard University, Boston, Massachusetts.
Thirushan WignakumarHarvard University, Boston, Massachusetts.
Jacob S BorgidaHarvard University, Boston, Massachusetts.
Thomas J PolicicchioHarvard University, Boston, Massachusetts.
George R HansonHennepin Healthcare, Minneapolis, Minnesota.
Olutayo M AleseHennepin Healthcare, Minneapolis, Minnesota.
William M RicciHospital of Special Surgery & NewYork-Presbyterian Hospital, New York.
Steve B BehrensHospital of Special Surgery & NewYork-Presbyterian Hospital, New York.
Aleksey DvorzhinskiyHospital of Special Surgery & NewYork-Presbyterian Hospital, New York.
Robert E BilodeauHospital of Special Surgery & NewYork-Presbyterian Hospital, New York.
Craig E KlingerHospital of Special Surgery & NewYork-Presbyterian Hospital, New York.
Brian H MullisIndiana University Health Methodist Hospital, Indianapolis.
Yohan JangIndiana University Health Methodist Hospital, Indianapolis.
Luke A LopasIndiana University Health Methodist Hospital, Indianapolis.
Todd O McKinleyIndiana University Health Methodist Hospital, Indianapolis.
Dillon C O'NeillIndiana University Health Methodist Hospital, Indianapolis.
Jan P SzatkowskiIndiana University Health Methodist Hospital, Indianapolis.
Walter W VirkusIndiana University Health Methodist Hospital, Indianapolis.
Lauren C HillIndiana University Health Methodist Hospital, Indianapolis.
Greg GaskiInova Fairfax Medical Campus, Fairfax, Virginia.
Robert A HymesInova Fairfax Medical Campus, Fairfax, Virginia.
James AhnInova Fairfax Medical Campus, Fairfax, Virginia.
Abraham M GochInova Fairfax Medical Campus, Fairfax, Virginia.
Michael HolzmanInova Fairfax Medical Campus, Fairfax, Virginia.
A Stephen MalekzadehInova Fairfax Medical Campus, Fairfax, Virginia.
Jeff E SchulmanInova Fairfax Medical Campus, Fairfax, Virginia.
Jessica C RiveraLouisiana State University, New Orleans.
Peter C KrauseLouisiana State University, New Orleans.
Carolyn BridgmanLouisiana State University, New Orleans.
Joseph CohenLoyola University Medical Center, Maywood, Illinois.
Carlo EikaniLoyola University Medical Center, Maywood, Illinois.
Maria ChavezLoyola University Medical Center, Maywood, Illinois.
Michelle KudulisLoyola University Medical Center, Maywood, Illinois.
Stephen J WarnerMcGovern Medical School at the University of Texas Health Science Center at Houston.
Timothy S AchorMcGovern Medical School at the University of Texas Health Science Center at Houston.
Andrew ChooMcGovern Medical School at the University of Texas Health Science Center at Houston.
Jonathan G EastmanMcGovern Medical School at the University of Texas Health Science Center at Houston.
Patrick J KellamMcGovern Medical School at the University of Texas Health Science Center at Houston.
Sterling J BoutteMcGovern Medical School at the University of Texas Health Science Center at Houston.
Keyla Denniss GuevaraMcGovern Medical School at the University of Texas Health Science Center at Houston.
Kristoff R ReidMedical University of South Carolina, Charleston.
Heather A VallierMetroHealth Medical Center, Cleveland, Ohio.
Anna Vergon TucciMetroHealth Medical Center, Cleveland, Ohio.
Jana M DavisPenn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania.
Alice C BellR. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore.
Marissa E BonyunR. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore.
Kathleen HealeyR. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore.
Vivian LiR. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore.
Natasha S McKibbenR. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore.
Jason NasconeR. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore.
David OkhuereigbeR. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore.
Marcus F SciadiniR. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore.
Gerard SlobogeanR. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore.
Nicolas ZingasR. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore.
Murali KovvurR. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore.
Joshua E LawrenceR. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore.
Heather PhippsR. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore.
Joshua RudnickiR. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore.
Kristin E TurnerR. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore.
Roman HaydaRhode Island Hospital at Brown University, Providence.
Andrew R EvansRhode Island Hospital at Brown University, Providence.
Stephen QuinnanSt Mary's Medical Center, West Palm Beach, Florida.
Alyha BenitezSt Mary's Medical Center, West Palm Beach, Florida.
Saqib RehmanTemple University Hospital, Philadelphia, Pennsylvania.
Melissa C SoderquistTemple University Hospital, Philadelphia, Pennsylvania.
Clay B TownsendTemple University Hospital, Philadelphia, Pennsylvania.
Cyrus CaroomTexas Tech University Health Sciences Center, Lubbock.
Angela C CollinsOhio State University Medical Center, Columbus.
Ebubechi OkwumabuaOhio State University Medical Center, Columbus.
Humza S ShaikhOhio State University Medical Center, Columbus.
Clay A SpitlerUniversity of Alabama at Birmingham.
Abhinav AgarwalUniversity of Alabama at Birmingham.
Michael D JohnsonUniversity of Alabama at Birmingham.
Justin M HallerUniversity of Utah, Salt Lake City.
Lucas S MarchandUniversity of Utah, Salt Lake City.
Nicholas A AlfonsoUniversity of Colorado Medicine, Aurora.
Melissa A GormanUniversity of Colorado Medicine, Aurora.
William Michael CharltonUniversity of Kentucky, Lexington.
Brandon R ScottUniversity of Kentucky, Lexington.
Kameron M KrausUniversity of Kentucky, Lexington.
Sean J MeredithUniversity of Maryland Capital Region Health, Largo.
Sneh TalwarUniversity of Maryland Capital Region Health, Largo.
Patrick F BerginUniversity of Mississippi Medical Center, Jackson.
Aaradhana J JhaUniversity of Mississippi Medical Center, Jackson.
Sheketha McGeeUniversity of Mississippi Medical Center, Jackson.
Priyanka V NeheteUniversity of Mississippi Medical Center, Jackson.
Tyranny A PryorUniversity of Mississippi Medical Center, Jackson.
Isaac SpearsUniversity of Mississippi Medical Center, Jackson.
Andrew T ChenUniversity of North Carolina School of Medicine, Chapel Hill.
Benjamin KelleyUniversity of North Carolina School of Medicine, Chapel Hill.
Nevaeh R NezUniversity of North Carolina School of Medicine, Chapel Hill.
William J ErtlUniversity of Oklahoma Medical Center, Oklahoma City.
Brandon R HullUniversity of Oklahoma Medical Center, Oklahoma City.
Sarah BlumenthalUniversity of Southern California Keck School of Medicine, Los Angeles.
Joseph T PattersonUniversity of Southern California Keck School of Medicine, Los Angeles.
Camille FlynnUniversity of Southern California Keck School of Medicine, Los Angeles.
Ryan C RossUniversity of Southern California Keck School of Medicine, Los Angeles.
Animesh AgarwalUniversity of Texas Health Sciences Center, San Antonio.
David B WeissUniversity of Virginia Medical Center, Charlottesville.
Michael M HadeedUniversity of Virginia Medical Center, Charlottesville.
Seth R YarboroUniversity of Virginia Medical Center, Charlottesville.
Tina DaoudUniversity of Virginia Medical Center, Charlottesville.
Eric D McVeyUniversity of Virginia Medical Center, Charlottesville.
Paul S WhitingUniversity of Wisconsin, Madison.
Christopher DomesUniversity of Wisconsin, Madison.
David C GoodspeedUniversity of Wisconsin, Madison.
Gabrielle R KuhnUniversity of Wisconsin, Madison.
Robert BoyceVanderbilt University Medical Center, Nashville, Tennessee.
Andres LibosVanderbilt University Medical Center, Nashville, Tennessee.
Phillip M MitchellVanderbilt University Medical Center, Nashville, Tennessee.
Andres Fidel Moreno-DiazVanderbilt University Medical Center, Nashville, Tennessee.
Robert Brandon PonceVanderbilt University Medical Center, Nashville, Tennessee.
Daniel J StinnerVanderbilt University Medical Center, Nashville, Tennessee.
Lauren M TatmanVanderbilt University Medical Center, Nashville, Tennessee.
Juanita Velasco-CastroVanderbilt University Medical Center, Nashville, Tennessee.
Karen TrochezVanderbilt University Medical Center, Nashville, Tennessee.
Jibanananda SatpathyVirginia Commonwealth University, Richmond.
David A ZuelzerVirginia Commonwealth University, Richmond.
Benjamin K PotterWalter Reed National Military Medical Center, Bethesda, Maryland.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Importance: Previous research has suggested that intrawound vancomycin powder reduces deep surgical site infections among patients with periarticular tibial fractures at high risk of infection. It is unknown whether the addition of tobramycin powder further decreases infection rates. Objective: To compare whether the combination of tobramycin plus vancomycin vs vancomycin alone delivered as intrawound powder at the time of definitive fixation reduces deep surgical site infections. Design, Setting, and Participants: Open-label, assessor-masked, randomized clinical trial conducted at 39 US trauma centers. Eligible patients were adults with an operatively treated periarticular tibial fracture (either tibial plateau or pilon) who met 1 of 3 criteria for elevated infection risk. Enrollment occurred between June 18, 2021, and December 12, 2024 (final follow-up, July 15, 2025). Interventions: Intrawound tobramycin (1.2 g) plus vancomycin (1.0 g) powder vs intrawound vancomycin (1.0 g) powder delivered at the time of definitive fixation. Main Outcomes and Measures: The primary outcome was a deep surgical site infection requiring surgical management within 182 days of definitive fracture fixation. Secondary outcomes included deep surgical site infections with pathogens that were gram-negative only, deep surgical site infections with at least 1 pathogen that was gram-positive, deep surgical site infections with polymicrobial cultures, deep surgical site infections with negative culture results, and cellulitis or skin infections treated only with antibiotics. Results: Among the 1660 participants randomized, 1528 (mean age, 47.0 [SD, 14.3] years; 603 female [39.5%]; 925 male [60.5%]) were included in the primary analysis. Deep surgical site infections occurred in 51 of 753 participants (182-day probability, 7.4%) in the tobramycin plus vancomycin group and 47 of 775 participants (182-day probability, 6.6%) in the vancomycin alone group (hazard ratio, 1.11; 95% bayesian credible interval, 0.75-1.66; posterior probability of superiority, 29.7%). The threshold required for superiority was not reached for any secondary outcome. Conclusions and Relevance: Among patients with operatively treated periarticular tibial fractures at high risk of infection, adding intrawound tobramycin powder to vancomycin powder at the time of definitive fixation did not reduce deep surgical site infections compared with vancomycin powder alone. Trial Registration: ClinicalTrials.gov Identifier: NCT02227446.

Indexed as

Antibiotic ProphylaxisSurgical Wound InfectionTibial FracturesTobramycinVancomycinAdultAnti-Bacterial AgentsDrug Therapy, CombinationFemaleFracture Fixation, InternalHumansMaleMiddle AgedPowdersTrauma CentersUnited StatesAnti-Bacterial AgentsPowdersTobramycinVancomycin

Identifiers

PMID41984450
PMCPMC13084553

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.