AzTrials
AzTrials

Surgical Site InfectionNCT05363462

Topical Antibiotics in Surgical Site

A study testing Vancomycin 1000 MG in people with Surgical Site Infection and Complication of Surgical Procedure, run by Universidad Autonoma de Nuevo Leon at 1 site in Mexico.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
Search all trials

Trial summary

Ankle fractures are one of the most common injuries in traumatology. It is the fourth most common fracture in general population after hip, wrist, and hand fractures. These injuries are the second cause of hospitalization due to fractures. Read more about this study

Who is it for?
Ages 18 to 65 yearsHealthy volunteers can take part
What is being tested?
Vancomycin 1000 MG
Could I receive a placebo?
No, everyone receives an active treatment
How many people
75 participants
Where
1 siteMexico
Study dates
5 Jan 2022to 12 Feb 2024
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 65 years
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Who may be able to join

  • • Patients older than 18 years
  • Patients with a closed fracture independently of mechanism and classification
  • Patients who require an open reduction with internal fixation surgery
  • Patients who decide to participate in the study

Who cannot join

  • Patients with exposed fractures
  • Presence of any form of immune deficiency
  • Vancomycin hyper sensibility
  • Surgery in the affected ankle within the last six months
  • Steroid usage
  • Antibiotic usage one week prior entry

Trial locations and contacts

1 site in 1 country.

Mexico1 site
  • Hospital Universitario "Dr. José E. González"

    Monterrey, Nuevo León, 64460

Other trials in Mexico

About this study

Official title: Use of Topical Broad-spectrum Antibiotics as a Prophylaxis for Surgical Site Infection

Ankle fractures are one of the most common injuries in traumatology. It is the fourth most common fracture in general population after hip, wrist, and hand fractures. These injuries are the second cause of hospitalization due to fractures.

Surgical site infections can be divided according to the Center of Disease Control (CDC) in superficial surgical site infections whose are defined as any infection that happens within the next 30 days after the procedure, they involve only the skin and subcutaneous tissue of the incision, and the patient presents at least one of the following: purulent drainage of the superficial incision, microorganisms isolation from an aseptically obtained culture of body fluid or tissue or the pain existence, tenderness or local inflammation at the superficial incision site despite negative cultures. Also, a diagnosis made by the surgeon or attending medic.

Read the detailed description

Ankle fractures are one of the most common injuries in traumatology. It is the fourth most common fracture in general population after hip, wrist, and hand fractures. These injuries are the second cause of hospitalization due to fractures. Despite the improvement in the ankle fracture management, it has been estimated that the ankle fracture incidence has been increasing and one of the motives is an increase of ageing population. It has been estimated that ankle fractures have an incidence between 71 to 187 cases per 100,000 inhabitants a year.

Most of the ankle fractures are due to fallings or traffic accidents, it has been reported that up to 71% from ankle fracture causes are due to mechanisms of low energy, especially among the elderly and those with comorbidities these injuries are commonly caused by the inversion of the ankle, where the force and weight of the body falls in the fibula, which in young individuals usually results in only an ankle sprain, being the conservative management the most effective treatment. Nevertheless, in aging patients, these same mechanisms can provoke a fracture.

Ankle fractures represent a challenge for the orthopedic surgeon because in this very joint, despite being relatively stable, rests the entire bodyweight and a correct approach is required for the functionality to not being affected.

Ankle fractures are classified according to AO/OTA and Danis-Weber classifications. Single malleolus fractures are the most frequent (43.7 - 10%) and inside the Orthopedic Trauma Association (OTA) classification, type B are more common with a 65.8%, which tend to be displaced fractures. In patients with unstable or displaced fractures, or where a severe dislocation exists, surgical intervention is advised.

These injuries require a surgical treatment, which brings another issue: surgical site infections.

Surgical site infections can be divided according to the CDC in superficial surgical site infections whose are defined as any infection that happens within the next 30 days after the procedure, they involve only the skin and subcutaneous tissue of the incision, and the patient presents at least one of the following: purulent drainage of the superficial incision, microorganisms isolation from an aseptically obtained culture of body fluid or tissue or the pain existence, tenderness or local inflammation at the superficial incision site despite negative cultures. Also, a diagnosis made by the surgeon or attending medic.

Deep incisional surgical site infections are defined as:

  1. An infection that occurs within the next 30 days after the surgery if no implant is there or a year after the surgery if there is an implant and the infection seems to be related with the procedure, where involves the deep tissue as fascial and muscular layers and presents:
  2. Purulent drainage from the deep incision
  3. Surgical incision that opens spontaneously or deliberately opened by a surgeon, and a positive culture
  4. If there is no positive culture, the presence of fever (> 38° Celsius degrees), pain or tenderness.
  5. An abscess or a diagnosis made by a surgeon or the attending medic. There are established risk factors for the development of surgical site infections, some of them are patient age, nutritional state, diabetes, smoking, obesity, altered immune state (8) and bacteria colonization due to contamination. This is relevant because S. aureus, negative coagulase Staphylococcus or Enterococcus are the most common causal agents for surgical site infections, which tend to be multiresistant to the most used antibiotics.

There is controversy in the prophylactic usage of antibiotics in the management of surgical injuries. The available literature supports the usage of prophylactic IV antibiotics 1 hour prior procedure and until 48 hours after, as defined by lead surgeon. Other prophylactic management is the usage of topical broad-spectrum antibiotics.

The information about the usage of topical broad-spectrum antibiotics is equally controversial. Topical vancomycin is advised in patients with surgeries that involve a high risk of developing severe and resistant infections such as spine, thorax, or cranium surgery, where its application has shown a decrease of surgical site infection acquisition risk. In one study, topical antibiotic application was carried out by irrigating 2.5 g of Vancomycin dissolved in 2 mL of saline solution before sternum incision, and at the procedure ending after injury closure. In some other studies 1 g of Vancomycin powder was placed over the cranium, then irrigated with saline solution before injury closure.

Nevertheless, these prophylaxis therapy has not been evaluated in patients under open ankle surgery with intern fixation. The available literature about these patients' management doesn´t oppose to the general surgical site infection guidelines.

Being tested
Vancomycin 1000 MG
Keywords
Antibiotic, Surgical site infection, Ankle fractures, Complication
Medical subject headings
Surgical Wound Infection, Ankle Fractures

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Vancomycin 1000 MGDrug

    Also called antibiotic, vancomycin

    Application of vancomycin in powder in the surgical site of treatment before closure of surgical wound

Study groups in NCT05363462
Study groupRoleWhat they receive
Ankle fracture surgical treated plus 1 g of topical vancomycinExperimentalA standard surgical treatment of patients with ankle fracture must be carried out. Classified according to Danis Webber classification system. Plus application of 1 g of vancomycin in powder in the surgical site
Receives: Drug: Vancomycin 1000 MG
Ankle fracture surgical treatedActive comparatorA standard surgical treatment of patients with ankle fracture must be carried out. Classified according to Danis Webber classification system
Receives: Drug: Vancomycin 1000 MG

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Rate of surgical infection site

    Defined as the number of patients with surgical infection site from the total of evaluated patients included in each group.

    Measured: 90 days

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted6 May 2022
  2. Study start5 Jan 2022
  3. Primary completion21 Dec 2023
  4. Study completion12 Feb 2024

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Model description
Two groups of treatment with a surgical ankle fracture 1. Surgical treatment 2. Surgical treatment plus 1 g of topical vancomycin
Masking
Single blind
Who is masked
Participant
Enrolment
75 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05363462
Sponsor's protocol ID
OR20-00007
Status last verified
Feb 2024
First submitted
2 May 2022
Last updated
14 Feb 2024
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Juto H, Nilsson H, Morberg P. Epidemiology of Adult Ankle Fractures: 1756 cases identified in Norrbotten County during 2009-2013 and classified according to AO/OTA. BMC Musculoskelet Disord. 2018 Dec 13;19(1):441. doi: 10.1186/s12891-018-2326-x.

    PubMed 30545314
  • Goost H, Wimmer MD, Barg A, Kabir K, Valderrabano V, Burger C. Fractures of the ankle joint: investigation and treatment options. Dtsch Arztebl Int. 2014 May 23;111(21):377-88. doi: 10.3238/arztebl.2014.0377.

    PubMed 24939377
  • Sun Y, Wang H, Tang Y, Zhao H, Qin S, Xu L, Xia Z, Zhang F. Incidence and risk factors for surgical site infection after open reduction and internal fixation of ankle fracture: A retrospective multicenter study. Medicine (Baltimore). 2018 Feb;97(7):e9901. doi: 10.1097/MD.0000000000009901.

    PubMed 29443762
  • Golano P, Vega J, de Leeuw PA, Malagelada F, Manzanares MC, Gotzens V, van Dijk CN. Anatomy of the ankle ligaments: a pictorial essay. Knee Surg Sports Traumatol Arthrosc. 2010 May;18(5):557-69. doi: 10.1007/s00167-010-1100-x. Epub 2010 Mar 23.

    PubMed 20309522
  • Elsoe R, Ostgaard SE, Larsen P. Population-based epidemiology of 9767 ankle fractures. Foot Ankle Surg. 2018 Feb;24(1):34-39. doi: 10.1016/j.fas.2016.11.002. Epub 2016 Nov 18.

    PubMed 29413771
  • Shao J, Zhang H, Yin B, Li J, Zhu Y, Zhang Y. Risk factors for surgical site infection following operative treatment of ankle fractures: A systematic review and meta-analysis. Int J Surg. 2018 Aug;56:124-132. doi: 10.1016/j.ijsu.2018.06.018. Epub 2018 Jun 18.

    PubMed 29929022
  • Ban KA, Minei JP, Laronga C, Harbrecht BG, Jensen EH, Fry DE, Itani KM, Dellinger EP, Ko CY, Duane TM. American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update. J Am Coll Surg. 2017 Jan;224(1):59-74. doi: 10.1016/j.jamcollsurg.2016.10.029. Epub 2016 Nov 30. No abstract available.

    PubMed 27915053
  • Gross CE, Green CL, DeOrio JK, Easley M, Adams S, Nunley JA 2nd. Impact of Diabetes on Outcome of Total Ankle Replacement. Foot Ankle Int. 2015 Oct;36(10):1144-9. doi: 10.1177/1071100715585575. Epub 2015 May 6.

    PubMed 25948694
  • Martin ET, Kaye KS, Knott C, Nguyen H, Santarossa M, Evans R, Bertran E, Jaber L. Diabetes and Risk of Surgical Site Infection: A Systematic Review and Meta-analysis. Infect Control Hosp Epidemiol. 2016 Jan;37(1):88-99. doi: 10.1017/ice.2015.249. Epub 2015 Oct 27.

    PubMed 26503187
  • Li S, Rong H, Zhang X, Zhang Z, Wang C, Tan R, Wang Y, Zheng T, Zhu T. Meta-analysis of topical vancomycin powder for microbial profile in spinal surgical site infections. Eur Spine J. 2019 Dec;28(12):2972-2980. doi: 10.1007/s00586-019-06143-6. Epub 2019 Sep 14.

    PubMed 31522274
  • Owen MT, Keener EM, Hyde ZB, Crabtree RM, Hudson PW, Griffin RL, Lowe JA. Intraoperative Topical Antibiotics for Infection Prophylaxis in Pelvic and Acetabular Surgery. J Orthop Trauma. 2017 Nov;31(11):589-594. doi: 10.1097/BOT.0000000000000941.

    PubMed 28708777
  • Mallela AN, Abdullah KG, Brandon C, Richardson AG, Lucas TH. Topical Vancomycin Reduces Surgical-Site Infections After Craniotomy: A Prospective, Controlled Study. Neurosurgery. 2018 Oct 1;83(4):761-767. doi: 10.1093/neuros/nyx559.

    PubMed 29267955

Questions about this trial

What is this clinical trial studying?

A study testing Vancomycin 1000 MG in people with Surgical Site Infection and Complication of Surgical Procedure, run by Universidad Autonoma de Nuevo Leon at 1 site in Mexico.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 14 Feb 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Mexico. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Rate of surgical infection site (time frame: 90 days). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05363462, which also lists 12 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 14 Feb 2024.

Free account

Log in to keep searching

You’ve used your 3 free searches. AzTrials is free: log in or create a free account to keep searching clinical trials and save the ones you want to follow.

Create a free accountLog in