Table 2.
Treatment Characteristics
| Author | Year | Preoperative Prophylaxis | Intraoperative Intervention Treatment | Intraoperative Control Treatment | Postoperative Prophylaxis |
|---|---|---|---|---|---|
| Intrawound antibiotics | |||||
| Garg et al | 2018 | IV cefazolin or vancomycin (depending on MRSA risk) | 0.5-2 g of vancomycin combined with autograft and placed subfascially | NR | Standard perioperative antibiotics |
| Thompson et al | 2018 | IV cefazolin or vancomycin (depending on MRSA risk) | 0.5-1 g of vancomycin powder applied over implants and bone graft before closure | NR | Oral cephalexin or oral sulfamethoxazole/trimethoprim for 2 days |
| Haller et al | 2017 | 50 mg/kg IV cefuroxime | 0.5 g of vancomycin powder placed between fascia and subcutaneous tissue before closure | Saline irrigation | NR |
| Hey et al | 2017 | 1000 mg IV cefazolin | 1 g of vancomycin powder in subfascial space | NR | IV cefazolin for 2 days |
| Liu et al | 2015 | IV cefazolin or clindamycin | 0.5-2 g of vancomycin powder evenly spread over muscle, fascia, implants, and autograft before closure | 1-2 L saline irrigation before wound closure | IV cefazolin or clindamycin every 8 hours for 1 day |
| Hill et al | 2014 | 1000-2000 mg IV cefazolin | 1-2 g of vancomycin powder into the wound before closure | NR | IV cefazolin for 1 day |
| Emohare et al | 2014 | Perioperative IV cefazolin | 1 g of vancomycin powder into all wound layers prior to closure | NR | Perioperative IV cefazolin |
| Theologis et al | 2014 | Routine perioperative antibiotics | 2 g of vancomycin powder in subfascial space | NR | Routine perioperative antibiotics |
| Tubaki et al | 2013 | 750 mg IV cefuroxime | 1 g of vancomycin powder placed directly onto the tissues, taking care not to expose bone graft or dura | 1 L saline irrigation | 750 mg IV cefuroxime every 8 hours for 1 day or until drain removal depending on noninstrumented or instrumented surgery |
| Strom et al (1)34 | 2013 | IV cefazolin | 1 g of vancomycin powder placed onto all tissues, taking care not to expose bone graft or instrumentation | 3 L pulse lavage with bacitracin prior to bone graft placement | NR |
| Strom et al (2)35 | 2013 | IV cefazolin | 1 g of vancomycin powder placed onto all tissues, taking care not to expose bone graft or instrumentation | 3 L pulse lavage with bacitracin prior to bone graft placement | NR |
| Pahys et al | 2013 | Standard IV perioperative cephalosporins | Preoperative alcohol foam disinfectant, 0.5 g of vancomycin powder added to the wound at the end of the procedure + second drain placement | NR | Standard IV perioperative cephalosporins |
| Caroom et al | 2013 | IV antibiotics according to policy | 1 g of vancomycin powder applied subfascially along bone graft and instrumentation after saline irrigation | NR | IV antibiotics according to policy, continued until 24 hours after drain removal |
| Heller et al | 2013 | 20 mg/kg IV cefazolin | 0.5-2 g of vancomycin powder into the wound before closure | NR | 1000 mg IV cefazolin every 8 hours for 1 day |
| Kim et al | 2013 | 1000 mg IV cefazolin | 1 g of vancomycin powder placed directly onto the tissues, taking care not to expose bone graft or dura | NR | 1000 mg IV cefazolin every 8 hours for 1 day |
| Sweet et al | 2011 | 2000 mg IV cefazolin | 1 g of vancomycin powder sprinkled into the deep and superficial portion of the wound before closure, 1 g mixed with bone graft | NR | IV cefazolin for 1 day |
| Intrawound antiseptics | |||||
| De Luna et al | 2017 | 1000 mg IV cefazolin | 2 L 3% povidone-iodine for 5-10 minutes, followed by 1 L saline irrigation prior to bone graft placement | 2 L saline irrigation for 5-10 minutes prior to bone graft placement | 1000 mg IV cefazolin every 12 hours for 2 days |
| Herwijnen et al | 2015 | Weight dependent IV flucloxacillin and gentamicin | 3 L saline irrigation followed by 1 L 1% povidone-iodine for 3 minutes followed by 3 L saline irrigation | 6 L saline irrigation followed by 1 L saline irrigation with 80 mg dissolved gentamicin | IV flucloxacillin every 8 hours for 1 day |
| Ulivieri et al | 2011 | 2000 mg IV amoxicillin + 400 mg IV clavulanic acid | Irrigation with solution of 10 mL 10% povidone-iodine + 5 mL H2O + 1 mL H2O2 for 1 minute followed by copious saline irrigation | NR | 6 hours postoperative 2000 mg IV amoxicillin + 400 mg IV clavulanic acid; 1000 mg amoxicillin + 200 mg clavulanic acid for 7 days if hardware was implanted |
| Chang et al | 2006 | 1000 mg IV cefazolin and 60 mg IV gentamicin | 0.35% povidone-iodine irrigation for 3 minutes followed by 2 L saline irrigation | 2 L saline irrigation | 1000 mg IV cefazolin every 6 hours and 60 mg IV gentamicin every 12 hours for 2 days; after that, oral cefazolin for 3 days |
Abbreviations: IV, intravenous; MRSA, methicillin-resistant Staphylococcus aureus; NR, not reported; H2O2, hydrogen peroxide.