Study of antibiotic efficacy of topical vancomycin powder in treatment of infected mandibular fractures and soft tissue surgical site infections

AIMS AND OBJECTIVE: To study the antibiotic efficacy of topical vancomycin in infected mandibular fracture treatment and its effect in preventing surgical site infections. MATERIALS AND METHODS: The study comprised of 100 subjects of infected mandibular fractures requiring open reduction and internal fixation, randomly categorized into two equal groups of 50 each, that is, vancomycin group (N = 50) treated for infected mandibular fractures with topical vancomycin powder used as adjunct and non-vancomycin group (N = 50). Clinical parameters like hospital stay, postoperative infections, postoperative fever, abnormal swelling, purulent discharge, and fistula formation at surgical site and radiographic healing was evaluated and compared between the groups. RESULTS: Mean age of vancomycin group and non-vancomycin group was 32.5 and 33.2 years, respectively. Demographic factors of the patients like age, sex, and hospital stay (3 ± 0.5 days) did not show significant difference between two groups. Vancomycin group shows 1 hyperthermia, 2 abnormal swelling and discharge, whereas non-vancomycin group shows 6 hyperthermia, 5 postoperative abnormal swelling and discharge with statistically significant (P < 0.05). Culture sensitivity of discharged fluid shows staphylococcal + MRSA infection in two patients in vancomycin group and eight patients in non-vancomycin group. Bony healing in vancomycin group shows one patient had non-union and one had graft rejection, whereas five patients had non-union and graft rejection in non- vancomycin group. The comparative results were statistically significant (P < 0.05). CONCLUSION: From the result of our study we can conclude that routine use of vancomycin powder in surgical site as a surgical adjunct reduces the incidence of infections at surgical site when it is applied in addition to standard antibiotic prophylaxis. Topical application into a surgical wound also reduces the risk associated with parenteral administration of vancomycin.