drugset / Trial / NCT04238923
Topical Gentamicin and Vancomycin for Vascular Surgical Site Infection Prophylaxis
Phase 2/3
Unknown
356 enrolled
London Health Sciences Centre Research Institute OR Lawson Research Institute of St. Joseph's
RandomizedParallel-groupTriple-blindPrevention
Summary
Many patients who undergo vascular surgery to improve the blood flow to their legs are at risk of developing an infection in the surgical site and are then at risk of serious complications such as hospital readmission, failure of the surgical procedure and lower limb amputation. Surgical site infections may be reduced in high-risk patients by applying two commonly used antibiotics (gentamicin and vancomycin) into the surgical incision at the end of the surgical procedure. This will be compared to the standard of care treatment at London Health Sciences Center.
Timeline
- Start
- 2020-05-01
- Primary completion
- 2021-05-01
- Completion
- 2021-07-01
Publications
- Background Nguyen LL, Brahmanandam S, Bandyk DF, Belkin M, Clowes AW, Moneta GL, Conte MS. Female gender and oral anticoagulants are associated with wound complications in lower extremity vein bypass: an analysis of 1404 operations for critical limb ischemia. J Vasc Surg. 2007 Dec;46(6):1191-1197. doi: 10.1016/j.jvs.2007.07.053.
- Background Giles KA, Hamdan AD, Pomposelli FB, Wyers MC, Siracuse JJ, Schermerhorn ML. Body mass index: surgical site infections and mortality after lower extremity bypass from the National Surgical Quality Improvement Program 2005-2007. Ann Vasc Surg. 2010 Jan;24(1):48-56. doi: 10.1016/j.avsg.2009.05.003. Epub 2009 Jul 19.
- Background Greenblatt DY, Rajamanickam V, Mell MW. Predictors of surgical site infection after open lower extremity revascularization. J Vasc Surg. 2011 Aug;54(2):433-9. doi: 10.1016/j.jvs.2011.01.034. Epub 2011 Mar 31.
- Background Vogel TR, Dombrovskiy VY, Carson JL, Haser PB, Lowry SF, Graham AM. Infectious complications after elective vascular surgical procedures. J Vasc Surg. 2010 Jan;51(1):122-9; discussion 129-30. doi: 10.1016/j.jvs.2009.08.006. Epub 2009 Dec 2.
- Background Culver DH, Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG, Banerjee SN, Edwards JR, Tolson JS, Henderson TS, et al. Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial Infections Surveillance System. Am J Med. 1991 Sep 16;91(3B):152S-157S. doi: 10.1016/0002-9343(91)90361-z.
- Background Turtiainen J, Hakala T. Surgical wound infections after peripheral vascular surgery. Scand J Surg. 2014 Dec;103(4):226-31. doi: 10.1177/1457496913514384. Epub 2014 Apr 15.
- Background Bandyk DF. Vascular surgical site infection: risk factors and preventive measures. Semin Vasc Surg. 2008 Sep;21(3):119-23. doi: 10.1053/j.semvascsurg.2008.05.008.
- Background Pevzner L, Swank M, Krepel C, Wing DA, Chan K, Edmiston CE Jr. Effects of maternal obesity on tissue concentrations of prophylactic cefazolin during cesarean delivery. Obstet Gynecol. 2011 Apr;117(4):877-882. doi: 10.1097/AOG.0b013e31820b95e4.
- Background Ott E, Bange FC, Sohr D, Teebken O, Mattner F. Risk factors associated with surgical site infections following vascular surgery at a German university hospital. Epidemiol Infect. 2013 Jun;141(6):1207-13. doi: 10.1017/S095026881200180X. Epub 2012 Aug 21.
- Background Siracuse JJ, Nandivada P, Giles KA, Hamdan AD, Wyers MC, Chaikof EL, Pomposelli FB, Schermerhorn ML. Prosthetic graft infections involving the femoral artery. J Vasc Surg. 2013 Mar;57(3):700-5. doi: 10.1016/j.jvs.2012.09.049. Epub 2013 Jan 9.
- Background Virkkunen J, Heikkinen M, Lepantalo M, Metsanoja R, Salenius JP; Finnvasc Study Group. Diabetes as an independent risk factor for early postoperative complications in critical limb ischemia. J Vasc Surg. 2004 Oct;40(4):761-7. doi: 10.1016/j.jvs.2004.07.040.
- Background Ramdev P, Rayan SS, Sheahan M, Hamdan AD, Logerfo FW, Akbari CM, Campbell DR, Pomposelli FB Jr. A decade experience with infrainguinal revascularization in a dialysis-dependent patient population. J Vasc Surg. 2002 Nov;36(5):969-74. doi: 10.1067/mva.2002.128297.
- Background Khan NR, Thompson CJ, DeCuypere M, Angotti JM, Kalobwe E, Muhlbauer MS, Camillo FX, Klimo P Jr. A meta-analysis of spinal surgical site infection and vancomycin powder. J Neurosurg Spine. 2014 Dec;21(6):974-83. doi: 10.3171/2014.8.SPINE1445. Epub 2014 Sep 26.
- Background Mohammed S, Pisimisis GT, Daram SP, Bechara CF, Barshes NR, Lin PH, Kougias P. Impact of intraoperative administration of local vancomycin on inguinal wound complications. J Vasc Surg. 2013 Apr;57(4):1079-83. doi: 10.1016/j.jvs.2012.09.073. Epub 2013 Jan 11.
- Background Fleischman AN, Austin MS. Local Intra-wound Administration of Powdered Antibiotics in Orthopaedic Surgery. J Bone Jt Infect. 2017 Jan 1;2(1):23-28. doi: 10.7150/jbji.16649. eCollection 2017.
- Background Ghobrial GM, Cadotte DW, Williams K Jr, Fehlings MG, Harrop JS. Complications from the use of intrawound vancomycin in lumbar spinal surgery: a systematic review. Neurosurg Focus. 2015 Oct;39(4):E11. doi: 10.3171/2015.7.FOCUS15258.
- Background Alcala-Cerra G, Paternina-Caicedo AJ, Moscote-Salazar LR, Gutierrez-Paternina JJ, Nino-Hernandez LM. [Application of vancomycin powder into the wound during spine surgery: systematic review and meta-analysis]. Rev Esp Cir Ortop Traumatol. 2014 May-Jun;58(3):182-91. doi: 10.1016/j.recot.2013.10.004. Epub 2014 Apr 2. Spanish.
- Background Xiong L, Pan Q, Jin G, Xu Y, Hirche C. Topical intrawound application of vancomycin powder in addition to intravenous administration of antibiotics: A meta-analysis on the deep infection after spinal surgeries. Orthop Traumatol Surg Res. 2014 Nov;100(7):785-9. doi: 10.1016/j.otsr.2014.05.022. Epub 2014 Oct 3.
- Background Kang DG, Holekamp TF, Wagner SC, Lehman RA Jr. Intrasite vancomycin powder for the prevention of surgical site infection in spine surgery: a systematic literature review. Spine J. 2015 Apr 1;15(4):762-70. doi: 10.1016/j.spinee.2015.01.030. Epub 2015 Jan 28.
- Background Chiang HY, Herwaldt LA, Blevins AE, Cho E, Schweizer ML. Effectiveness of local vancomycin powder to decrease surgical site infections: a meta-analysis. Spine J. 2014 Mar 1;14(3):397-407. doi: 10.1016/j.spinee.2013.10.012. Epub 2013 Oct 30.
- Background Bakhsheshian J, Dahdaleh NS, Lam SK, Savage JW, Smith ZA. The use of vancomycin powder in modern spine surgery: systematic review and meta-analysis of the clinical evidence. World Neurosurg. 2015 May;83(5):816-23. doi: 10.1016/j.wneu.2014.12.033. Epub 2014 Dec 19.
- Background Evaniew N, Khan M, Drew B, Peterson D, Bhandari M, Ghert M. Intrawound vancomycin to prevent infections after spine surgery: a systematic review and meta-analysis. Eur Spine J. 2015 Mar;24(3):533-42. doi: 10.1007/s00586-014-3357-0. Epub 2014 May 18.
- Background Hussain ST. Local application of gentamicin-containing collagen implant in the prophylaxis and treatment of surgical site infection following vascular surgery. Int J Surg. 2012;10 Suppl 1:S5-9. doi: 10.1016/j.ijsu.2012.05.015. Epub 2012 May 29.
- Background Horch R, Kronung G. [Prevention of infection in teflon prostheses for dialysis access. Experiences with a resorbable combined collagen-antibiotic system]. Vasa. 1989;18(1):30-4. German.
- Background Holdsworth J. Treatment of infective and potentially infective complications of vascular bypass grafting using gentamicin with collagen sponge. Ann R Coll Surg Engl. 1999 May;81(3):166-70.
- Background Friberg O, Svedjeholm R, Soderquist B, Granfeldt H, Vikerfors T, Kallman J. Local gentamicin reduces sternal wound infections after cardiac surgery: a randomized controlled trial. Ann Thorac Surg. 2005 Jan;79(1):153-61; discussion 161-2. doi: 10.1016/j.athoracsur.2004.06.043.
- Background Kowalewski M, Pawliszak W, Zaborowska K, Navarese EP, Szwed KA, Kowalkowska ME, Kowalewski J, Borkowska A, Anisimowicz L. Gentamicin-collagen sponge reduces the risk of sternal wound infections after heart surgery: Meta-analysis. J Thorac Cardiovasc Surg. 2015 Jun;149(6):1631-40.e1-6. doi: 10.1016/j.jtcvs.2015.01.034. Epub 2015 Jan 23.
- Background Ruszczak Z, Friess W. Collagen as a carrier for on-site delivery of antibacterial drugs. Adv Drug Deliv Rev. 2003 Nov 28;55(12):1679-98. doi: 10.1016/j.addr.2003.08.007.
- Background Andreas M, Muckenhuber M, Hutschala D, Kocher A, Thalhammer F, Vogt P, Fleck T, Laufer G. Direct sternal administration of Vancomycin and Gentamicin during closure prevents wound infection. Interact Cardiovasc Thorac Surg. 2017 Jul 1;25(1):6-11. doi: 10.1093/icvts/ivx032.
- Cristino MA, Nakano LC, Vasconcelos V, Correia RM, Flumignan RL. Prevention of infection in aortic or aortoiliac peripheral arterial reconstruction. Cochrane Database Syst Rev. 2025 Apr 22;4(4):CD015192. doi: 10.1002/14651858.CD015192.pub2.
Drugs
| Evaluation | Drug | Modality | Dose | Route |
|---|---|---|---|---|
| Subject | Gentamicin | Small molecule | 2 unknown | Topical |
| Subject | Vancomycin | Other / unclassified | 1 g | Topical |