Top

European Journal of Trauma and Emergency Surgery

Open Access 11-03-2024 | Antibiotic | Original Article

Effectiveness of combined local therapy with antibiotics and fibrin vs. vacuum-assisted wound therapy in soft tissue infections: a retrospective study

Authors: S. Kaiser, R. D. Verboket, J. Frank, I. Marzi, M. Janko

Published in: European Journal of Trauma and Emergency Surgery

Abstract

Purpose

Soft tissue infections can be severe and life-threatening. Their treatment consists currently in radical surgical wound debridement and combined systemic antimicrobial therapy. Different side effects are possible. Local antibiotic therapy represents a new approach to reduce side effects and improve healing. The aim of this study is to assess the effectiveness of the local sprayed use of antibiotics with fibrin sealing compared with negative pressure wound therapy as an established treatment of soft-tissue infections.

Methods

In this retrospective study, patients with soft tissue infections who underwent surgical treatment were analysed. One group consists of patients, who received local fibrin-antibiotic spray (FAS) (n = 62). Patients treated by vacuum-assisted wound therapy (VAWT) as the established treatment were the control group (n = 57). Main outcomes were differences in the success of healing, the duration until healing and the number of needed operations.

Results

Clinical healing could be achieved for 55 patients (98.21%) in the FAS group vs. 47 patients (92.16%) in the VAWT group (p = 0.19). Time to require this was 10.65 ± 10.38 days in the FAS group and 22.85 ± 14.02 days in the VAWT group (p < 0.001). In the FAS group, patients underwent an average of 1.44 ± 0.72 vs.3.46 ± 1.66 operations in the VAWT group (p < 0.001).

Conclusion

Compared to vacuum-assisted wound therapy in soft tissue infections, local fibrin-antibiotic spray shows faster clinical healing and less needed operations. Leading to shorter hospital stays and more satisfied patients. The combination of sprayed fibrin and antibiotics can be seen as a promising and effective method.

Bisno AL, Stevens DL. Streptococcal infections of skin and soft tissues. N Engl J Med. 1996;334(4):240–5. https://doi.org/10.1056/NEJM199601253340407.CrossRefPubMed

Sendi P, Zimmerli W. Antimicrobial treatment concepts for orthopaedic device-related infection. Clin Microbiol Infect. 2012;18(12):1176–84. https://doi.org/10.1111/1469-0691.12003.CrossRefPubMed

Chiummariello S, Guarro G, Pica A, Alfano C. Evaluation of negative pressure vacuum-assisted system in acute and chronic wounds closure: our experience. G Chir. 2012;33(10):358–62.PubMed

Peinemann F, Sauerland S. Negative-pressure wound therapy: systematic review of randomized controlled trials. Dtsch Arztebl Int. 2011;108(22):381–9. https://doi.org/10.3238/arztebl.2011.0381.CrossRefPubMedPubMedCentral

Robert N. Negative pressure wound therapy in orthopaedic surgery. Orthop Traumatol Surg Res. 2017;103(1S):S99–103. https://doi.org/10.1016/j.otsr.2016.04.018.CrossRefPubMed

Strugala V, Martin R. Meta-analysis of comparative trials evaluating a prophylactic single-use negative pressure wound therapy system for the prevention of surgical site complications. Surg Infect (Larchmt). 2017;18(7):810–9. https://doi.org/10.1089/sur.2017.156.CrossRefPubMed

Liu X, Zhang H, Cen S, Huang F. Negative pressure wound therapy versus conventional wound dressings in treatment of open fractures: a systematic review and meta-analysis. Int J Surg. 2018;53:72–9. https://doi.org/10.1016/j.ijsu.2018.02.064.CrossRefPubMed

Miola M, Bistolfi A, Valsania MC, Bianco C, Fucale G, Verné E. Antibiotic-loaded acrylic bone cements: an in vitro study on the release mechanism and its efficacy. Mater Sci Eng C Mater Biol Appl. 2013;33(5):3025–32. https://doi.org/10.1016/j.msec.2013.03.032.CrossRefPubMed

Bonne SL, Kadri SS. Evaluation and management of necrotizing soft tissue infections. Infect Dis Clin North Am. 2017;31(3):497–511. https://doi.org/10.1016/j.idc.2017.05.011.CrossRefPubMedPubMedCentral

10.

Garcia NM, Cai J. Aggressive soft tissue infections. Surg Clin North Am. 2018;98(5):1097–108. https://doi.org/10.1016/j.suc.2018.05.001.CrossRefPubMed

11.

Hoffman-Terry ML, Fraimow HS, Fox TR, Swift BG, Wolf JE. Adverse effects of outpatient parenteral antibiotic therapy. Am J Med. 1999;106(1):44–9. https://doi.org/10.1016/s0002-9343(98)00362-3.CrossRefPubMed

12.

Pulcini C, Couadau T, Bernard E, et al. Adverse effects of parenteral antimicrobial therapy for chronic bone infections. Eur J Clin Microbiol Infect Dis. 2008;27(12):1227–32. https://doi.org/10.1007/s10096-008-0570-y.CrossRefPubMed

13.

Jo J-H, Harkins CP, Schwardt NH, et al. Alterations of human skin microbiome and expansion of antimicrobial resistance after systemic antibiotics. Sci Transl Med. 2021;13(625):eabd8077. https://doi.org/10.1126/scitranslmed.abd8077.CrossRefPubMedPubMedCentral

14.

Fleege C, Rauschmann M, Arabmotlagh M, Rickert M. Entwicklung und aktueller Einsatz von lokalen Antibiotikaträgern bei Spondylodiszitis : Pilotstudie zur Verkürzung der Dauer einer systemischen Therapie. Orthopade. 2020;49(8):714–23. https://doi.org/10.1007/s00132-020-03942-4.CrossRefPubMed

15.

Khan NR, Thompson CJ, DeCuypere M, et al. A meta-analysis of spinal surgical site infection and vancomycin powder. J Neurosurg Spine. 2014;21(6):974–83. https://doi.org/10.3171/2014.8.SPINE1445.CrossRefPubMed

16.

Bennett-Guerrero E, Pappas TN, Koltun WA, et al. Gentamicin-collagen sponge for infection prophylaxis in colorectal surgery. N Engl J Med. 2010;363(11):1038–49. https://doi.org/10.1056/NEJMoa1000837.CrossRefPubMed

17.

Murphy EP, Curtin M, Shafqat A, Byrne F, Jadaan M, Rahall E. A review of the application of vancomycin powder to posterior spinal fusion wounds with a focus on side effects and infection. A prospective study. Eur J Orthop Surg Traumatol. 2017;27(2):187–91. https://doi.org/10.1007/s00590-016-1878-4.CrossRefPubMed

18.

Fleischman AN, Austin MS. Local intra-wound administration of powdered antibiotics in orthopaedic surgery. J Bone Jt Infect. 2017;2(1):23–8. https://doi.org/10.7150/jbji.16649.CrossRefPubMedPubMedCentral

19.

Singh G, Passi D, Daga D, Manas A, Vignesh U, Bhave SM. Study of antibiotic efficacy of topical vancomycin powder in treatment of infected mandibular fractures and soft tissue surgical site infections. J Family Med Prim Care. 2019;8(10):3340–4. https://doi.org/10.4103/jfmpc.jfmpc_661_19.CrossRefPubMedPubMedCentral

20.

Kühn K-D, Renz N, Trampuz A. Lokale Antibiotikatherapie. Unfallchirurg. 2017;120(7):561–72. https://doi.org/10.1007/s00113-017-0372-8.CrossRefPubMed

21.

Penn-Barwell JG, Murray CK, Wenke JC. Local antibiotic delivery by a bioabsorbable gel is superior to PMMA bead depot in reducing infection in an open fracture model. J Orthop Trauma. 2014;28(6):370–5. https://doi.org/10.1097/BOT.0b013e3182a7739e.CrossRefPubMed

22.

Jackson MR. Fibrin sealants in surgical practice: an overview. Am J Surg. 2001;182(2 Suppl):1S-7S. https://doi.org/10.1016/s0002-9610(01)00770-x.CrossRefPubMed

23.

Spotnitz WD. Hemostats, sealants, and adhesives: a practical guide for the surgeon. Am Surg. 2012;78(12):1305–21.CrossRefPubMed

24.

Tofuku K, Koga H, Yanase M, Komiya S. The use of antibiotic-impregnated fibrin sealant for the prevention of surgical site infection associated with spinal instrumentation. Eur Spine J. 2012;21(10):2027–33. https://doi.org/10.1007/s00586-012-2435-4.CrossRefPubMedPubMedCentral

25.

Ahmad E, Fatima MT, Hoque M, Owais M, Saleemuddin M. Fibrin matrices: the versatile therapeutic delivery systems. Int J Biol Macromol. 2015;81:121–36. https://doi.org/10.1016/j.ijbiomac.2015.07.054.CrossRefPubMed

26.

Tredwell S, Jackson JK, Hamilton D, Lee V, Burt HM. Use of fibrin sealants for the localized, controlled release of cefazolin. Can J Surg. 2006;49(5):347–52.PubMedPubMedCentral

27.

Redl H, Schlag G, Stanek G, Hirschl A, Seelich T. In vitro properties of mixtures of fibrin seal and antibiotics. Biomaterials. 1983;4(1):29–32. https://doi.org/10.1016/0142-9612(83)90066-2.CrossRefPubMed

28.

Kram HB, Bansal M, Timberlake O, Shoemaker WC. Antibacterial effects of fibrin glue-antibiotic mixtures. J Surg Res. 1991;50(2):175–8. https://doi.org/10.1016/0022-4804(91)90243-f.CrossRefPubMed

29.

Nakaminami H, Suzuki Y, Suzuki R, Saito A, Motomura N, Noguchi N. In vitro antimicrobial activity of fibrin sealants containing antimicrobial agents. Surg Infect (Larchmt). 2014;15(1):29–35. https://doi.org/10.1089/sur.2012.224.CrossRefPubMed

30.

Ulatowski L, Meier M, Goymann V, Thümler P. Zur Wirkung eines Fibrin-Antibiotikum-Verbundes bei Knochen- und Weichteil-Infektionen. Fortschr Med. 1981;99(22):864–8.PubMed

31.

Cashman JD, Jackson JK, Mugabe C, et al. The use of tissue sealants to deliver antibiotics to an orthopaedic surgical site with a titanium implant. J Orthop Sci. 2013;18(1):165–74. https://doi.org/10.1007/s00776-012-0325-6.CrossRefPubMed

32.

Djenić N, Višnjić M, Dragović S, et al. Experimental closure of gunshot wounds by fibrin glue with antibiotics in pigs. Vojnosanit Pregl. 2015;72(9):785–93. https://doi.org/10.2298/vsp131106050d.CrossRefPubMed

33.

Ozaki S, Saito A, Nakaminami H, Ono M, Noguchi N, Motomura N. Comprehensive evaluation of fibrin glue as a local drug-delivery system-efficacy and safety of sustained release of vancomycin by fibrin glue against local methicillin-resistant Staphylococcus aureus infection. J Artif Organs. 2014;17(1):42–9. https://doi.org/10.1007/s10047-013-0746-9.CrossRefPubMed

34.

Schwartz RJ, Dubrow TJ, Rival RA, Wilson SE, Williams RA. The effect of fibrin glue on intraperitoneal contamination in rats treated with systemic antibiotics. J Surg Res. 1992;52(2):123–6. https://doi.org/10.1016/0022-4804(92)90291-7.CrossRefPubMed

35.

Verboket R, Marzi I, Fleck SC, Frank J, Janko M. Local fixation of antibiotics with fibrin spray on soft tissues: experimental study on the relevance of the application techniques. Eur J Trauma Emerg Surg. 2018;46(3):635–40. https://doi.org/10.1007/s00068-018-1054-0.CrossRefPubMed

36.

Janko M, Dust F, Wagner PV, et al. Local fixation of colistin with fibrin spray: an in vivo animal study for the therapy of skin and soft tissue infections. Front Surg. 2022;9:749600. https://doi.org/10.3389/fsurg.2022.749600.CrossRefPubMedPubMedCentral

37.

Kejwal MB, Verboket RD, Sommer K, et al. Local gentamicin fixation with sprayed fibrin-an in vivo animal study reveals new options to treat soft tissue infections. J Clin Med. 2023;12(10). https://doi.org/10.3390/jcm12103390

38.

Janko M, Nau C, Marzi I, Frank J. Lokale Antibiotikafixation durch Fibrinbesprühung: Bei Knocheninfekten mit Weichteilbeteiligung. Chirurg. 2017;88(2):166–74. https://doi.org/10.1007/s00104-016-0320-0.CrossRefPubMed

39.

von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61(4):344–9. https://doi.org/10.1016/j.jclinepi.2007.11.008.CrossRef

40.

Benchimol EI, Smeeth L, Guttmann A, et al. The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statement. PLoS Med. 2015;12(10):e1001885. https://doi.org/10.1371/journal.pmed.1001885.CrossRefPubMedPubMedCentral

41.

Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC Definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606–8. https://doi.org/10.1017/S0195941700015241.CrossRefPubMed

42.

Berríos-Torres SI, Umscheid CA, Bratzler DW, et al. Centers for disease control and prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg. 2017;152(8):784–91. https://doi.org/10.1001/jamasurg.2017.0904.CrossRefPubMed

43.

Hofmann GO. Infektionen der Knochen und Gelenke in Traumatologie und Orthopädie. 1. Aufl. München, Jena: Elsevier, Urban und Fischer; 2004.

44.

Mader JT, Stevens CM, Stevens JH, Ruble R, Lathrop JT, Calhoun JH. Treatment of experimental osteomyelitis with a fibrin sealant antibiotic implant. Clin Orthop Relat Res. 2002;403:58–72. https://doi.org/10.1097/00003086-200210000-00011.CrossRef

45.

Yasir M, Willcox MDP, Dutta D. Action of antimicrobial peptides against bacterial biofilms. Materials (Basel). 2018;11(12). https://doi.org/10.3390/ma11122468.

46.

Dhesi JK, Moppett IK. Anaesthesia and the older brain: what should we do? Anaesthesia. 2022;77(Suppl 1):8–10. https://doi.org/10.1111/anae.15636.CrossRefPubMed

47.

Barnes J, Hunter J, Harris S, et al. Systematic review and consensus definitions for the Standardised Endpoints in Perioperative Medicine (StEP) initiative: infection and sepsis. Br J Anaesth. 2019;122(4):500–8. https://doi.org/10.1016/j.bja.2019.01.009.CrossRefPubMedPubMedCentral

48.

Moonesinghe SR, Jackson AIR, Boney O, et al. Systematic review and consensus definitions for the Standardised Endpoints in Perioperative Medicine initiative: patient-centred outcomes. Br J Anaesth. 2019;123(5):664–70. https://doi.org/10.1016/j.bja.2019.07.020.CrossRefPubMed

49.

Myles PS, Boney O, Botti M, et al. Systematic review and consensus definitions for the Standardised Endpoints in Perioperative Medicine (StEP) initiative: patient comfort. Br J Anaesth. 2018;120(4):705–11. https://doi.org/10.1016/j.bja.2017.12.037.CrossRefPubMed

50.

Bai AD, Dai C, Srivastava S, Smith CA, Gill SS. Risk factors, costs and complications of delayed hospital discharge from internal medicine wards at a Canadian academic medical centre: retrospective cohort study. BMC Health Serv Res. 2019;19(1):935. https://doi.org/10.1186/s12913-019-4760-3.CrossRefPubMedPubMedCentral

51.

Everall AC, Guilcher SJT, Cadel L, Asif M, Li J, Kuluski K. Patient and caregiver experience with delayed discharge from a hospital setting: a scoping review. Health Expect. 2019;22(5):863–73. https://doi.org/10.1111/hex.12916.CrossRefPubMedPubMedCentral

52.

Spotnitz WD, Burks S. Hemostats, sealants, and adhesives III: a new update as well as cost and regulatory considerations for components of the surgical toolbox. Transfusion. 2012;52(10):2243–55. https://doi.org/10.1111/j.1537-2995.2012.03707.x.CrossRefPubMed

53.

Chotitumnavee J, Parakaw T, Srisatjaluk RL, et al. In vitro evaluation of local antibiotic delivery via fibrin hydrogel. J Dent Sci. 2019;14(1):7–14. https://doi.org/10.1016/j.jds.2018.08.010.CrossRefPubMed

54.

Nishimura J, Nakajima K, Souma Y, et al. The possibility of using fibrin-based collagen as an antibiotic delivery system. Surg Today. 2013;43(2):185–90. https://doi.org/10.1007/s00595-012-0210-0.CrossRefPubMed

55.

Lewis PO, Heil EL, Covert KL, Cluck DB. Treatment strategies for persistent methicillin-resistant Staphylococcus aureus bacteraemia. J Clin Pharm Ther. 2018;43(5):614–25. https://doi.org/10.1111/jcpt.12743.CrossRefPubMed

56.

Tacconelli E, Carrara E, Savoldi A, et al. Discovery, research, and development of new antibiotics: the WHO priority list of antibiotic-resistant bacteria and tuberculosis. Lancet Infect Dis. 2018;18(3):318–27. https://doi.org/10.1016/S1473-3099(17)30753-3.CrossRefPubMed

57.

Agarwal P, Kukrele R, Sharma D. Vacuum assisted closure (VAC)/negative pressure wound therapy (NPWT) for difficult wounds: a review. J Clin Orthop Trauma. 2019;10(5):845–8. https://doi.org/10.1016/j.jcot.2019.06.015.CrossRefPubMedPubMedCentral

58.

Madrigal P, Moshal T, Bernabe R, Yenikomshian H, Gillenwater J. A comparison of negative pressure wound therapy modalities, VAC versus non-commercial NPWT alternatives: a systematic review of RCTs/CCTs. J Tissue Viability. 2022;31(4):630–6. https://doi.org/10.1016/j.jtv.2022.10.002.CrossRefPubMed

59.

Wild T, Otto F, Mojarrad L, Kellner M, Götzinger P. Vakuumversiegelung-Grundlagen, Indikationen, Kontraindikationen und Kostenbilanz. Ther Umsch. 2007;64(9):495–503. https://doi.org/10.1024/0040-5930.64.9.495.CrossRefPubMed

60.

Barringer CB, Gorse SJ, Burge TS. The VAC dressing–a cautionary tale. Br J Plast Surg. 2004;57(5):482. https://doi.org/10.1016/j.bjps.2004.01.005.CrossRefPubMed

61.

White RA, Miki RA, Kazmier P, Anglen JO. Vacuum-assisted closure complicated by erosion and hemorrhage of the anterior tibial artery. J Orthop Trauma. 2005;19(1):56–9. https://doi.org/10.1097/00005131-200501000-00011.CrossRefPubMed

Title: Effectiveness of combined local therapy with antibiotics and fibrin vs. vacuum-assisted wound therapy in soft tissue infections: a retrospective study
Authors: S. Kaiser
R. D. Verboket
J. Frank
I. Marzi
M. Janko
Publication date: 11-03-2024
Publisher: Springer Berlin Heidelberg
Keywords: Antibiotic
Soft Tissue Infection
Vacuum Therapy
Vacuum Therapy
Vacuum Therapy
Wound Management
Published in: European Journal of Trauma and Emergency Surgery
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-024-02483-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Effectiveness of combined local therapy with antibiotics and fibrin vs. vacuum-assisted wound therapy in soft tissue infections: a retrospective study

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content