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Vancomycin Soaking to Reduce Intraoperative Contamination by Cutibacterium acnes During the Latarjet Procedure.
- Source :
-
The American journal of sports medicine [Am J Sports Med] 2024 Sep; Vol. 52 (11), pp. 2843-2849. Date of Electronic Publication: 2024 Aug 23. - Publication Year :
- 2024
-
Abstract
- Background: Postoperative infection after the Latarjet procedure, ranging from 1% to 6%, can compromise the functional outcome of young athletes. Cutibacterium acnes is a main pathogen as a consequence of an intraoperative contamination.<br />Purpose: To evaluate intraoperative contamination with C. acnes and the effectiveness of the local application of vancomycin during the Latarjet procedure.<br />Study Design: Cohort study; Level of evidence, 2.<br />Methods: This was a single-center study including 75 patients (mean age, 26 years; range, 15-55 years) operated on for anterior shoulder instability with the primary open Latarjet procedure; they underwent the same protocol of skin preparation and preoperative prophylactic antibiotics. Three groups of 25 patients were created and divided sequentially, without the results of each group being known before the end of the study: group A (5 mg/mL of vancomycin), group B (20 mg/mL of vancomycin), and group C (control group with no vancomycin). Swab samples of the coracoid were taken before sectioning the coracoid process (time 1) and after its preparation (time 2). The coracoid was then wrapped in gauze impregnated with different concentrations of vancomycin, except for group C. A final sample (time 3) was taken before screwing the bone block onto the glenoid. All samples were cultured for 21 days, and patients underwent clinical and radiological follow-up for 6 months.<br />Results: The C. acnes contamination rates at times 1, 2, and 3 were 25%, 44%, and 45%, respectively, without significant difference. There was no significant difference between groups A and B with respect to the number of positive cultures at each time point. Of 9 positive cultures at time 1, all were still positive at time 3 in group A, whereas 3 of 5 were negative in group B ( P = .027). The rate of C. acnes at time 3 in the control group was higher than that in the 2 other groups (68% vs 44% for group A and 20% for group B; P = .003). Body mass index was the only prognostic factor for a C. acnes -positive culture (26.05 ± 3.39 vs 23.34 ± 2.33; P = .018). No clinical infection was reported at the 6-month postoperative follow-up.<br />Conclusion: The rate of C. acnes contamination ranged from 25% to 68% during the open Latarjet procedure in young athletes. Vancomycin reduced the bacterial contamination when it was used at high concentrations in a gauze wrap on the coracoid. The type of C. acnes detected and its clinical implications remain to be studied.<br />Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: N.B. has received consulting fees and royalties from Move up. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.
- Subjects :
- Humans
Adolescent
Male
Young Adult
Adult
Female
Middle Aged
Antibiotic Prophylaxis methods
Propionibacterium acnes
Gram-Positive Bacterial Infections prevention & control
Gram-Positive Bacterial Infections microbiology
Cohort Studies
Vancomycin administration & dosage
Vancomycin therapeutic use
Anti-Bacterial Agents therapeutic use
Anti-Bacterial Agents administration & dosage
Surgical Wound Infection prevention & control
Surgical Wound Infection microbiology
Subjects
Details
- Language :
- English
- ISSN :
- 1552-3365
- Volume :
- 52
- Issue :
- 11
- Database :
- MEDLINE
- Journal :
- The American journal of sports medicine
- Publication Type :
- Academic Journal
- Accession number :
- 39175370
- Full Text :
- https://doi.org/10.1177/03635465241266621