This study is a retrospective cohort analysis involving 276 patients who underwent bone tumor resection and megaprosthetic reconstruction, with 134 patients receiving an additional 1g of vancomycin powder locally post-surgery. Results demonstrated an infection rate of 5.9% in the vancomycin group compared to 19.7% in the control group, and multivariable competing risks regression analysis confirmed local vancomycin significantly reduces infection risk (HR: 0.40).
Literature Overview
This article, 'Local Vancomycin Application Reduces Periprosthetic Joint Infections in Oncologic Megaprosthetic Reconstruction,' published in Antibiotics, reviewed 276 patients undergoing bone tumor resection and megaprosthetic reconstruction, with 134 receiving local vancomycin powder postoperatively. The study revealed significantly lower infection rates compared to the control group (142 patients receiving only intravenous antibiotics) and utilized the 2018 International Consensus Meeting (ICM) diagnostic criteria for infections. After two-year follow-up, vancomycin application reduced infection rates (5.9% vs. 19.7%), with primary pathogens identified as coagulase-negative staphylococci (CNS) and Staphylococcus aureus.
Background Knowledge
Patients undergoing megaprosthetic reconstruction after bone tumor surgery face elevated risks of periprosthetic joint infections (PJI), with reported infection rates up to 50%. Local antibiotic application offers a potential strategy to enhance surgical site drug concentration while minimizing systemic toxicity. This article further validates the efficacy of local vancomycin in bone tumor surgery, investigates its impact across tumor locations and infection risks, and provides novel insights for postoperative infection control. The study also highlights the higher infection risk associated with pelvic tumors (HR: 5.82), emphasizing the critical role of local antibiotics in complex procedures.
Research Methods and Experiments
The study included 276 patients who underwent bone tumor resection and megaprosthetic reconstruction, with 142 assigned to the control group (standard perioperative intravenous antibiotics) and 134 receiving 1g of vancomycin powder locally during wound closure. A retrospective cohort design was employed, with postoperative infections evaluated using the 2018 ICM criteria and a two-year follow-up period. Multivariable competing risks regression models (Fine and Gray method) were applied to assess the independent effect of local vancomycin on infection prevention, adjusting for confounding factors including age, sex, BMI, tumor type, tumor location, and preoperative chemotherapy.
Key Conclusions and Perspectives
Research Significance and Prospects
This study demonstrates that local vancomycin application may effectively reduce postoperative PJI in bone tumor patients, particularly against Gram-positive pathogens. However, as a retrospective analysis using a 1g dose, further randomized controlled trials are required to confirm its efficacy and explore higher doses (e.g., 2g) for improved infection prevention. The study also recommends combining local antibiotics with broader-spectrum agents to address Gram-negative infections, thereby enhancing the postoperative infection prevention framework.
Conclusion
Bone tumor resection and megaprosthetic reconstruction carry high infection risks, but local antibiotic application offers a feasible adjunctive strategy. This study shows that applying 1g of local vancomycin during wound closure significantly reduces PJI rates without inducing wound healing complications, providing evidence-based support for infection management in bone tumor surgery. Although pelvic tumors exhibit higher infection risks, local vancomycin still demonstrates notable prophylactic benefits. Future large-scale randomized controlled trials are needed to validate its role in oncologic prosthetic surgery and optimize dosing and application protocols.
