Does Topical Vancomycin Powder Use in Fracture Surgery Change Bacteriology and Antibiotic Susceptibilities? An Analysis of the VANCO Trial.

Topical vancomycin powder decreases the likelihood of gram-positive infections consistent with the biologic activity of vancomycin. Fewer MSSA and CoNS infections were observed in the group treated with vancomycin powder. An effect of vancomycin powder on MRSA infection risk was not detected given the low incidence in both the intrawound vancomycin and standard of care groups. There was no emergence of gram-negative rod infections or increased resistance patterns observed. Use of topical vancomycin powder does not appear to produce infections in these patients with greater antibiotic resistance than would have occurred without its use.